Doctors Weigh in on the Right Way to Stop Prescribed Opioids

Conservative News DailyDecember 8, 2022

Opioid addiction and the illness and death associated with the misuse of these drugs is a growing health crisis.

Last year, the Centers for Disease Control and Prevention (CDC) made headlines with news that 2021 saw an unprecedented number of overdose deaths from opioid use.

Although these drugs can offer relief for people with chronic pain or who have experienced surgery, they do come with risks, particularly opioid use disorder (OUD)—the chronic use of opioids that causes “clinically significant” distress or impairment, including dependence and even addiction to opioids.

However, only brief use or abruptly stopping opioid use might not solve the problem. Are there better ways to prevent issues related to opioid use and can we avoid using these drugs at all?

‘Negative Reinforcement’ Could Increase OUD Risk

“There could be significant risk of acute discontinuation or overly aggressive tapering plans,” Anna Legreid Dopp, PharmD, Senior Director of Clinical Guidelines and Quality Improvement at the American Society of Health-System Pharmacists (ASHP), told The Epoch Times.

She added that this could result in “acute” withdrawal symptoms in patients with physical dependence on opioids.

A study looked at Medicaid patients and found that abruptly discontinuing opioid use was associated with increased rates of death and suicide.

It also showed that the risk wasn’t reduced by prescribing buprenorphine, a drug used to reduce withdrawal symptoms.

Recent research even suggests that abruptly ceasing opioid use significantly increases the risk of developing OUD.

Orman Trent Hall, DO, an addiction medicine specialist and assistant professor of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center and College of Medicine, said we don’t fully understand why sudden discontinuation of opioids increases the risk of developing OUD.

“One possibility involves a form of learning called negative reinforcement,” he explained.

He said that this happens when patients are quickly forced off opioids, and experience a “crisis” of uncontrolled pain.

“If they begin using illegal opioids during this crisis,” he continued. “They will learn to associate illegal opioids with relief.” Later, when other life stressors come up, they may feel the only way to cope is by using illegal opioids.

However, according to Tucker Woods, DO, chair of the emergency department and associate medical director of Lenox Health Greenwich Village, sudden discontinuation of opioids does not “cause” OUD.

Woods explained that sudden discontinuation of opioids can cause opioid withdrawal syndrome after a patient has developed “dependence,” generally due to prolonged use.

“But [that] doesn’t necessarily mean the patient has opioid use disorder,” he said.

Woods clarified the difference is that withdrawal symptoms are experienced when a dependent person doesn’t have the drug. However, OUD is when a person compulsively seeks out the drug despite negative consequences.

A Better Way to Cut Opioid Use: Tapering Dosages

According to the Department of Health and Human Services (HHS), opioid dosing should be “tapered,” rather than abruptly cut.

It may be appropriate to begin reducing doses when there is an improvement in pain, when pain and function aren’t “meaningfully” improved, or when there may be signs of OUD.

The agency cautions that healthcare providers should taper slowly enough to minimize withdrawal symptoms. Tapering plans should also be individualized for each patient’s goals.

“The longer the duration of previous opioid therapy, the longer the taper may take,” advised HHS. “Common tapers involve dose reduction of five percent to 20 percent every four weeks.”

Long and Short-Term Use Both Carry Addiction Risk

Recent research indicates that for 29 percent of heroin users, their first opioid was prescribed in an emergency room (ED), while another study finds that even a five to nine-day prescription was linked to significantly increased odds of long-term use (90 days or more).

The study authors concluded that ED opioid prescriptions could contribute to the development of addiction in some patients.

Dopp said chronic pain is a very serious patient concern, but the benefits of managing chronic pain with long-term opioid therapy “lacks evidence.”

“What we do know is that the longer a patient takes an opioid, the higher their risk is for side effects, misuse, and addiction,” she said.

Dopp explained that this also depends on the patient and how much opioid they may have been taking.

Treating and Preventing OUD

Woods emphasized that while treating addiction to opioids is not a “one size fits all” approach, opioid agonist therapy can be an effective treatment for individuals struggling with OUD.

“There are only two FDA-approved drugs on the planet that have been shown in studies to reduce opioid overdose deaths,” he said. “And one is an opioid agonist [methadone] and the other medication is what is called a “partial agonist” [buprenorphine].”

Woods noted that these drugs can be life-saving.

“Buprenorphine, for example, prevents cravings for opioids, prevents withdrawal from opioids, and also keeps the patient safe, will block other opioids if a patient has a return to use of other opioids.”

He added that there are alternatives—for example, a monthly injectable medication called naltrexone, which is an opioid antagonist that actually blocks opioids and helps with cravings.

Alternatives to Opioid Therapy

Experts say that there are alternatives to opioid drugs for pain relief.

Woods said that healthcare providers could stop providing these drugs and still offer effective pain relief.

“There are so many other options out there other than opioids for effective pain relief,” he said.

The American Society of Anesthesiologists (ASA) lists safe and effective options that include aspirin, ibuprofen, and acetaminophen.

They also note nondrug remedies such as massage, acupuncture, and ‘high-tech’ treatments using radio waves and electrical signals.

“Patients with chronic pain deserve effective treatment tailored to fit their individual needs,” said Hall.

He explained that alternative treatment may involve Physical or Occupational Therapy, non-opioid pain medications, adaptive equipment like braces, supports or sleeves, medical procedures, or surgeries.

“Some of the most effective pain treatments people can do on their own,” said Wood.

He recommended getting better sleep, managing stress, and exercising, which have been shown to improve pain and function.

The most important point is that according to experts, in many cases, opioid drugs can be completely avoided to eliminate the risk of addiction to these powerful, and potentially dangerous drugs.