Patients prescribed opioid pain medications whose doses varied over time were 3 times more likely to experience an overdose than patients prescribed stable opioid doses, according to an observational study from Kaiser Permanente published today in JAMA Network Open. The study also showed that patients who discontinued long-term opioid therapy for 3 or more months had half the risk of opioid overdose.
“Our study suggests that safely managing long-term opioid therapy is complex,” said Ingrid Binswanger, MD, senior investigator at Kaiser Permanente Institute for Health Research in Colorado and co-author of the study.
“This study suggests going up and down on opioid doses — also called dose variability — could present an increased risk of overdose,” Dr. Binswanger said. “Through this study, we also found eventually discontinuing opioid therapy may prevent overdoses. With continued studies, we hope to find out how care providers can help patients with their pain without putting them at unnecessary risk due to rapid changes in their dose.”
The 12-year study included more than 14,000 Kaiser Permanente members in Colorado who were prescribed long-term opioids. Researchers used electronic health records to track the history of patients to see if they had dose changes and overdoses from opioid pain medications and other opioid drugs.
The research team obtained a follow-up $2 million, 4-year grant from the National Institutes for Health. The study will look at how patients and doctors manage changes in opioid doses, including any long-term risks and benefits of discontinuing opioid pain medications.
“Kaiser Permanente, like many health care organizations across the country, has made significant changes to safely reduce opioid prescriptions for our members,” said Jason Glanz, PhD, senior investigator at the Institute for Health Research and co-author on the study.
“This study represents the first of many investigations that we plan to do on the topic,” Dr. Glanz said. “Our goal is to help identify the most safe and effective approaches for managing long-term opioid therapy. We want to be able to minimize patients’ pain and reduce their risk for overdose.”
This study was funded by the National Institute on Drug Abuse and conducted by researchers at Kaiser Permanente’s Institute for Health Research.
Additional study authors include Susan Shetterly, MS; Komal J. Narwaney, MPH, PhD; and Stan Xu, PhD.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.4 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share
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