EXPERTS from Monash University have warned against rapidly reducing or abruptly stopping prescription opioids after finding it significantly increases the risk of mental health or substance use-related emergency presentations.
In research published in the journal Pain, the team analysed data from nearly 1,500 Victorian adults on long-term opioid therapy who presented to emergency departments for mental health or substance use-related conditions between 2018 and 2022.
They found that rapid dose reductions of more than 25% over a 30-day period, or stopping opioids entirely, were associated with more than 10 times the odds of emergency presentation compared with gradual reductions of 10-25%, which is what is recommended in Australia's opioid deprescribing guidelines.
It was also found that concurrent prescriptions for gabapentinoids, benzodiazepines, or other psychotropic medications further increased risks during opioid dose reductions.
The most common mental health presentations were depressive episodes (17%), suicidal ideation (13%) and anxiety disorders (11%).
Lead author Dr Monica Jung said the findings have important implications for clinical practice.
"Our research shows that when opioid doses are reduced gradually, there isn't an increased risk of mental health emergencies," Dr Jung said.
"However, larger or abrupt reductions can have serious consequences," she explained.
"This tells us that deprescribing opioids requires careful planning, patient support and close monitoring - the good news is that gradual tapering appears to be a safer approach."
The study also highlighted the need for better support systems during opioid tapering, said co-author and deputy director of Monash Addiction Research Centre, Professor Suzanne Nielsen.
"While reducing opioid prescribing overall is important for public health, we need to ensure individual patients are supported through this process," Professor Nielsen said.
"For patients taking gabapentinoids, benzodiazepines, or other psychotropic medications, extra caution and support may be needed during opioid dose reductions to prevent adverse outcomes," she suggested.
Read the study HERE. KB
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