The link between reducing pain medication, overdose and mental health crisis

In response to the concerning numbers of opioid-related deaths in the US, there has been a recent focus on opioid prescribing trends, which has shown an increase in opioid tapering among patients prescribed long-term opioid therapy. However, there has also been an increase in opioid-related mortality.

This article examines the relationship between opioid dose tapering among patients prescribed stable, long-term, higher-dose opioids and rates of overdose and mental health crisis.

On examination of 114,000 patients who had been prescribed "stable, high doses of opioids", the researchers identified over 29,000 patients whose doses were subsequently reduced by 15 percent or more. Records of these patients were then analysed to identify "overdose or withdrawal events" and "mental health crisis events," including depression or anxiety and suicide attempts, during follow-up periods of up to a year.

Findings from the study show:

• Posttapering periods were associated with higher rates of overdose events compared to compared nontapered periods
• Posttapering periods were associated with higher rates of mental health crisis events compared to compared nontapered periods

These findings suggest that among the patients prescribed stable, long-term, higher-dose opioid therapy, tapering events were significantly associated with increased risk of overdose and mental health crisis. 

The authors conclude "clinicians and patients must carefully weigh risks and benefits of both opioid continuation and tapering in decisions regarding ongoing opioid therapy.".