Photo Credit: Rattankun

The following is a summary of “Management of patients at risk of harms from both continuing and discontinuing their long-term opioid therapy: A qualitative study to inform the gap in clinical practice guidelines,” published in the November 2024 issue of Pain by Timko et al. 

Researchers conducted a retrospective study to evaluate clinical practice guidelines for patients with long-term opioid therapy (LTOT), where both continuation and tapering pose risks, and opioid use disorder (OUD) is absent.  

They addressed the gap in guidelines by using a multiple case study approach; 5, 5 cases were developed to explore variations in key aspects of LTOT continuation and discontinuation risks among individuals reporting LTOT’s lack of efficacy, including pain and poor function. Treatment strategies were gathered from 28 opioid safety experts (19 physicians) who participated in a national policy panel and were analyzed through template analysis.  

The results showed that experts recommended a slow taper for patients on LTOT with risks from continuation and discontinuation, even after an unsuccessful attempt, and suggested discontinuing opioid therapy. Buprenorphine was considered for patients with aberrant behaviors, and non-opioid therapies were recommended, especially if previously ineffective. Shared decision-making was advised, though there was limited consensus on methods. Some experts addressed co-occurring conditions affecting safety, like alcohol use and mental health symptoms. Few experts discussed OUD or overdose risk. In quantitative findings, 36% of experts believed LTOT was beneficial, 36% recommended discontinuation, and 57% agreed that tapering and discontinuation caused harm.  

Investigators concluded that further research is needed to validate the efficacy of tapering LTOT and incorporating non-opioid pain therapies for patients experiencing harm from both continued and discontinued opioid therapy to inform evidence-based clinical guidelines.  

Source: onlinelibrary.wiley.com/doi/abs/10.1111/papr.13440