Strong support from family members and health care providers looms key to helping patients trying to scale back or stop their use of potentially dangerous opioid painkillers, according to a new Colorado study.
The project, done by a team of researchers from the University of Colorado School of Medicine and the U.S. Department of Veterans Affairs’ Eastern Colorado Health Care System, sought to examine patient views on tapering back chronic opioid therapy amid evidence of increased risks and questionable long-term benefits from using prescription opioids for pain management.
“That support is key and will be challenging for many primary-care practices, where providers already busy seeing patients in limited time windows,” said Dr. Joseph Frank, an assistant professor at the CU medical school, a primary care physician and lead author of the study.
“We got richer detail about what the experience of taking opioid medications long-term and making plans to stop them was all about. We heard very vivid stories about how challenging and unpleasant that process can be. We also heard stories about how it went well, the ways people felt better on the other side, and how their health care team supported the process.”
Frank said some patients related how they leaned on loved ones when deciding when to scale back use of opioid painkillers, while others noted that input from peers who had worked through opioid use could be even more valuable than talking to their doctor.
“How to communicate with patients is important,” he said. “Participants told us these conversations are often difficult, and we need to learn how to do that well in primary care in particular.”
Opioids, which are highly addictive, encompass prescription drugs and illegal narcotics such as heroin. The Colorado study focused on medications prescribed by a physician. Opioid use for managing chronic pain has come under increasing scrutiny in recent months amid concerns about misuse and overdose, leading to new, more-conservative guidelines this year from the Centers for Disease Control and Prevention and more-stringent product warning labels from federal regulators.
Colorado ranked 12th in the nation for “nonmedical use” of opioid painkillers in 2012 and 2013, according to state statistics. A recent report on substance abuse in Colorado suggested the overall rate of hospitalizations and deaths from prescription opioids in the state has leveled while those related to heroin use continue to rise. Prescription drug death rates remain nearly nine times as high statewide as those for heroin.
The CU-VA study conducted hour-long, in-depth interviews with 24 patients from three health care systems in the metro area to examine their perspectives on decreasing opioid medication or stopping it altogether.
The patients described difficulties complicated by factors such as anxiety and fear of increased pain and confusion over medication changes. But once the transition from opioids had been made, they reported improved quality of life.
Frank also noted that the patients in the study reported that they didn’t consider themselves at risk of overdosing on opioid painkillers. Another finding that surfaced in a few patient conversations was that in Colorado, where medical and recreational marijuana are legal, physicians struggle with how to handle patients who use both at the same time as a pain management strategy.
“It will be important to educate both providers and patients with information on how to safely manage the two,” Frank said. “There isn’t evidence currently to guide patients or providers what the risks are, or the benefits, of taking the two at the same time.”
The study’s results were reported in an article published online by Pain Medicine. The work was funded by the Small Grants Program at the Division of General Internal Medicine at the CU School of Medicine.
