Abstract
BackgroundEfforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients’ experiences.ObjectiveTo explore patients’ perspectives on opioid taper experiences to ultimately improve taper processes and outcomes.DesignQualitative study.ParticipantsPatients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of ≥50% in the past 2 years in two distinct medical systems and regions.ApproachFrom 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers.Key ResultsParticipants (n=41) had lived with chronic pain for an average of 17.4 years (range, 3–36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes.ConclusionsFrom patients’ perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships and communication influence patients’ perceptions of the quality and outcomes of opioid tapers. To improve patients’ experiences of opioid tapers, tapering plans should be based on individualized risk-benefit assessments and involve patient-centered approaches and improved provider communication.
Highlights
Higher opioid analgesic dosages are associated with increased rates of drug-related overdose morbidity and mortality.[1,2,3]
The Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016, which was associated with a reduced prevalence of higher opioid analgesic dosages.[1]
Participants had lived with chronic pain for an average of 17.4 years, which they related to various injuries and conditions including arthritis, Behcet’s disease, Crest syndrome, Crohn’s disease, diabetes, fibromyalgia, Grave’s disease, injuries, and sickle cell anemia
Summary
Higher opioid analgesic dosages are associated with increased rates of drug-related overdose morbidity and mortality.[1,2,3] recent clinical trials comparing opioids to alternatives have raised questions about the effectiveness of opioids for chronic pain.[4,5] In recent years, several federal agencies have published safe opioid-prescribing guidelines recommending tapering to reduce dosages or discontinue in some situations.[6,7,8,9] The Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016, which was associated with a reduced prevalence of higher opioid analgesic dosages.[1]There is limited guidance about best practices to taper opioid analgesics. Reports of patient harms from abrupt opioid discontinuation prompted the CDC Guideline authors to clarify that evidence did not support abrupt opioid discontinuation and caution against this practice.[10] State-level programs and initiatives to taper opioid dosages or set dosage limits have become more common; early evidence suggests only modest reductions in opioid prescribing, while broader impacts on opioid-related mortality, morbidity, and pain control remain unknown.[11,12,13] a systematic review found that evidence on patients’ toleration of opioid tapering was of low. Narratives highlighted the consequential role of patientprovider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. CONCLUSIONS: From patients’ perspectives, opioid tapers can produce significant physical, emotional, and
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