"To date, opioid-tapering research reports on costly and largely inaccessible inpatient programs or resource-intensive structured outpatient opioid reduction programs," Darnall told MedPage Today. "We tested a community-based, voluntary opioid tapering approach that any prescriber can implement with limited to no resources, just some basic training in methodology."
To lessen withdrawal symptoms, physicians decreased opioid doses up to 5% for up to two dose reductions in the first month. In months 2 to 4, patients were asked to reduce doses by as much as 10% per week, with increments tailored to each patient. Physicians monitored patients with close clinical follow-up at least once a month, adjusting doses as needed.
After 4 months, researchers administered follow-up surveys. Of 82 patients, 31 did not complete the 4-month survey and were considered to have dropped out of the study. Depression negatively correlated (P=0.05) and baseline marijuana use positively correlated (P=0.04) with completing the study.
To confirm results of the 51 patients who finished the study, researchers reviewed medical records, periodic urine tests, and the state Prescription Drug Monitoring Program (PDMP), and found no aberrations in compliance or prescriptions.
At baseline, the median daily MME of study completers was 288 mg and they had a median of 6 years of opioid use. Pain intensity was 5 out of 10 on a numeric pain rating.
After 4 months, the median daily MME dropped to 150 mg (P=0.002). Pain intensity (P=0.29) and pain interference (P=0.44) did not increase.
This research shows dose and duration may not be as important as we think, Darnall observed.
"Common lore is that patients taking high dose opioids are unlikely to have successful outpatient opioid taper results -- or if they have been taking opioids for years or even decades they will likely have a poor taper response," she said. "To the contrary, we found that starting dose and duration of use did not predict taper response."