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Cited by 18Opioid Use Disorder TreatmentPain Management and Opioid UseSubstance Abuse Treatment and Outcomes

Opioid tapering in patients with prescription opioid use disorder: A retrospective study

Zhou, Kehua, Jia, Peng, Bhargava, Swati, Zhang, Yong, Reza, Taslima, Peng, Yuan Bo, Wang, Gary G.·2017·Scandinavian Journal of Pain
DOI 10.1016/j.sjpain.2017.09.005
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Abstract

Background and aims: Opioid use disorder (OUD) refers to a maladaptive pattern of opioid use leading to clinically significant impairment or distress. OUD causes, and vice versa, misuses and abuse of opioid medications. Clinicians face daily challenges to treat patients with prescription opioid use disorder. An evidence-based management for people who are already addicted to opioids has been identified as the national priority in the US; however, options are limited in clinical practices. In this study, we aimed to explore the success rate and important adjuvant medications in the medication assisted treatment with temporary use of methadone for opioid discontinuation in patients with prescription OUD. Methods: This is a retrospective chart review performed at a private physician office for physical medicine and rehabilitation. We reviewed all medical records dated between December 1st, 2011 and August 30th, 2016. The initial evaluation of the included patients ( N =140) was completed between December 1st, 2011 and December 31st, 2014. They all have concumittant prescription OUD and chronic non-cancer pain. The patients (87 female and 53 male) were 46.7 ± 12.7 years old, and had a history of opioid use of 7.7 ±6.1 years. All patients received the comprehensive opioid taper treatments (including interventional pain management techniques, psychotherapy, acupuncture, physical modalities and exercises, and adjuvant medications) on top of the medication assisted treatment using methadone (transient use). Opioid tapering was considered successful when no opioid medication was used in the last patient visit. Results: The 140 patients had pain of 9.6 ± 8.4 years with 8/10 intensity before treatment which decreased after treatment in all comparisons ( p < 0.001 for all). Opioids were successfully tapered off in 39 (27.9%) patients after 6.6 ±6.7 visits over 8.8 ±7.2 months; these patients maintained opioid abstinence over 14.3 ± 13.0 months with regular office visits. Among the 101 patients with unsuccessful opioid tapering, 13 patients only visited the outpatient clinic once. Significant differences were found between patients with and without successful opioid tapering in treatment duration, number of clinic visits, the use of mirtazepine, bupropion, topiramate, and trigger point injections with the univariate analyses. The use of mirtazepine (OR, 3.75; 95% CI, 1.48–9.49), topiramate (OR, 5.61; 95% CI, 1.91–16.48), or bupropion (OR, 2.5; 95% CI, 1.08–5.81) was significantly associated with successful opioid tapering. The associations remain significant for mirtazepine and topiramate (not bupropion) in different adjusted models. Conclusions: With comprehensive treatments, 27.9% of patients had successful opioid tapering with opioid abstinence for over a year. The use of mirtazepine, topiramate, or likely bupropion was associated with successful opioid tapering in the medication assisted treatment with temporary use of methadone. Opioid tapering may be a practical option and should be considered for managing prescription OUD. Implications: For patients with OUD, indefinite opioid maintenance treatment may not be necessary. Considering the ethical values of autonomy, nonmaleficence, and beneficence, clinicians should provide patients with OUD the option of opioid tapering.

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Authors
Zhou, K., Jia, P., Bhargava, S., Zhang, Y., Reza, T., Peng, Y. B., & Wang, G. G.
Affiliations
  • Sisters of Charity Hospital (US)
  • International Institute for Geo-Information Science and Earth Observation (NL)
  • Chongqing Medical University (CN)
  • Avalon University School of Medicine (CW)
  • The University of Texas at Arlington (US)
Corresponding author
  • Zhou, Kehua
  • Wang, Gary G.
ORCID
Venue
Scandinavian Journal of Pain
Publisher
Walter de Gruyter GmbH
Published
2017-10-01
Volume
17
Issue
1
Pages
167-173
ISSN
  • 1877-8860 (ISSN-L)
  • 1877-8879
DOI
10.1016/j.sjpain.2017.09.005
OpenAlex
W2764311355
Cited by
18
References
28
Citations by year
2025: 3 · 2024: 5 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 1
FWCI
1.28
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Scandinavian Journal of Pain (publishedVersion)
  • PubMed (publishedVersion)
  • University of Twente Research Information (publishedVersion)
  • University of Twente Research Information (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
prescription opioid use disorder, opioid tapering, opioid discontinuation, chronic non-cancer pain, methadone maintenance treatment, medication-assisted treatment, bupropion, topiramate, trigger point injection, acupuncture, psychotherapy, treatment success rate, opioid abstinence, treatment duration, clinic visits, rehabilitation medicine, interventional pain management
MeSH terms
Analgesics, Opioid, Female, Humans, Male, Methadone, Middle Aged, Opioid-Related Disorders, Pain, Drug Prescriptions, Retrospective Studies, Opiate Substitution Treatment, Chronic Pain, Pain Management

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