Taking prescription opioids for too long can be harmful. Here’s how to cut back and stop
- Written by The Conversation
Opioids, such as oxycodone, morphine, codeine, tramadol and fentanyl, are commonly prescribed to manage pain. You might be given a prescription when experiencing pain, or after surgery or an injury.
But while opioids may relieve pain in the short term, they provide little to no lasting improvement in pain or function beyond a few weeks for people whose pain isn’t caused by cancer.
Opioids can also cause side effects such as nausea, constipation and drowsiness, as well as serious risks such as dependence and overdose.
Over the past decade, Australia has introduced initiatives to reduce opioid use and related harm. This includes new guidelines that recommend reducing the dose or stopping opioids when the risks of continuing outweigh the benefits.
Many people can reduce or stop opioids without their pain worsening. Some people even experience less pain. However, for some people, reducing or stopping opioids can result in worse pain, mental health crises and even suicide.
Our new research, published today in the New England Journal of Medicine, explains how to safely reduce and stop taking prescription opioids.
How do you know when it’s time to stop? Then what?
Determining whether it is appropriate to reduce or stop opioids depends on several factors unique to each person. These include:
- why opioids were prescribed
- how long they’ve been used
- what other treatments you’ve tried
- how the medication affects your pain, function and quality of life
- your life circumstances.
If it’s appropriate to trial reducing or stopping opioids, guidelines from Australia, the United Kingdom and the United States emphasise the following principles:
1) Shared decision-making
Shared decision-making is where health-care professionals and patients work together to set goals, weigh risks and benefits, and make informed choices.
This means collaboratively designing an opioid reduction plan that reflects the person’s needs, preferences and circumstances, rather than imposing a one-size-fits-all approach.
Research shows shared decision-making may lead to better outcomes, and patients value this process.
2) Reduce gradually
Stopping opioids suddenly can cause withdrawal symptoms such as anxiety, insomnia, and stomach upset. Rapid dose reductions can also increase the risk of overdose, mental distress and suicide.
To avoid these risks, opioids should be reduced gradually over weeks, months or even longer. The process should be flexible, allowing for pauses or adjustments to the reduction plan if needed.
When someone takes lower doses of opioids over time, their body’s tolerance decreases. If they return to a higher dose, there is a risk of overdose. For this reason, health-care professionals may recommend having naloxone available. This is a medication that can reverse an opioid overdose.
Read more: Naloxone can reverse opioid overdose. Here's why you might need some at home or in your bag
3) Set up other supports
Supportive strategies should be used before, during and after reducing opioids. These can include:
- physical therapies such as physiotherapy
- psychological approaches such as mindfulness
- non-opioid medications
- mental health support from health-care professionals, friends and family
- education about pain self-management.
The evidence supporting specific interventions is often limited or uncertain. Choosing a strategy will depend on your individual preferences and access. The best approach is likely a combination of several different supports.
4) See your health-care provider for ongoing monitoring
Regular monitoring from a health-care professional is recommended during and after opioid reduction to assess pain, function, withdrawal symptoms and wellbeing.
This can help to ensure that any issues are identified early and are addressed.
If someone experiences a clear decline in their quality of life, for example, it may be necessary to pause or stop the taper and revisit it later, provide extra supports or implement strategies to manage withdrawal symptoms.
We need a health system that supports this process
Making opioid reduction safer and more effective requires putting these principles into practice. But many patients and health-care professionals still face challenges when doing so.
It’s best practice to access a team-based pain management program with support from a doctor, physiotherapist and psychologist, among other providers, to manage pain and reduce the use of opioids. But access to these services remains limited in many parts of Australia.
Consumer organisations and professional bodies have called for greater access to team-based pain services so more people, especially those living in rural and under-served areas, can access support.
Australian health-care professionals have also requested more education and training in pain management, prescribing and opioid reduction, as well as stronger evidence about what works, for whom and why. This is so they’re better able to tailor their care to each person’s needs.
Other strategies such as reducing the amount of opioids prescribed – including after surgery – have also been proposed to help prevent long-term opioid use and the need for reduction plans later on.
