Patients’ Perspectives on Tapering of Chronic Opioid Therapy: A Qualitative Study

Abstract

OBJECTIVE : There is inadequate evidence of long-term benefit and growing evidence of the risks of chronic opioid therapy (COT). Opioid dose reduction, or opioid tapering, may reduce these risks but may also worsen pain and quality of life. Our objective was to explore patients' perspectives on opioid tapering. DESIGN : Qualitative study using in-person, semistructured interviews. SETTING AND PATIENTS : English-speaking, adult primary care patients (N = 24) in three Colorado health care systems. METHODS : Interviews were audio recorded, transcribed, and analyzed in ATLAS.ti. We used a team-based, mixed inductive and deductive approach guided by the Health Belief Model. We iteratively refined emergent themes with input from a multidisciplinary team. RESULTS : Participants had a mean age of 52 years old, were 46% male and 79% white. Six participants (25%) were on COT and not tapering, 12 (50%) were currently tapering COT, and 6 (25%) had discontinued COT. Emergent themes were organized in four domains: risks, barriers, facilitators, and benefits. Patients perceived a low risk of overdose and prioritized the more immediate risk of increased pain with opioid tapering. Barriers included a perceived lack of effectiveness of nonopioid options and fear of opioid withdrawal. Among patients with opioid tapering experience, social support and a trusted health care provider facilitated opioid tapering. These patients endorsed improved quality of life following tapering. CONCLUSIONS : Efforts to support opioid tapering should elicit patients' perceived barriers and seek to build on relationships with family, peers, and providers to facilitate tapering. Future work should identify patient-centered, feasible strategies to support tapering of COT.

Blocking microglial pannexin-1 channels alleviates morphine withdrawal in rodents

“…To alleviate or avoid the aversive symptoms of withdrawal, many of these individuals continue to use opiates [1][2][3][4] . Withdrawal is therefore a key determinant of opiate use in dependent individuals, yet its underlying mechanisms are poorly understood and effective therapies are lacking.…”

“I'm Not Gonna Pull the Rug out From Under You”: Patient-Provider Communication About Opioid Tapering

“…For example, when doctors showed genuine concern for their patients’ health and well-being, patients with chronic pain seemed more willing to accept decisions to limit or deny opioids. 22 In a recent study involving interviews with patients being tapered off of opioids, Frank and colleagues 13 reported that patients believed having a trusted physician was essential. Studies have shown that when patients and their PCPs have similar concerns about opioids, they can approach these concerns collaboratively.…”

“…4,16,23 Collaboration and trust are especially important as nonopioid treatments are explored and as patients face fears of opioid withdrawal or uncontrolled pain. Indeed, in Frank and colleagues’ 13 interviews, patients revealed that withdrawal and uncontrolled pain were major barriers to opioid tapering. Further corroborating the importance of provider support during opioid tapering, a recent pilot study reported that patients randomized to a taper support intervention involving psychiatric consultation and weekly meetings with a physician assistant showed greater improvement on pain interference, pain self-efficacy, and perceived opioid problems, than control patients.…”

La disminución de opioides puede mejorar los resultados de los pacientes con dolor crónico

“…Los riesgos potenciales incluyen los síntomas por síndrome de abstinencia, incremento del dolor y pérdida de seguimiento (15). Sin embargo, algunos pacientes informaron mejoras en la función y calidad de vida después de la disminución (16). Los efectos de la disminución de la dosis de opiodes y los resultados en los pacientes no han sido sistemáticamente revisados.…”