Clinical Implications of Tapering Chronic Opioids in a Veteran Population

Abstract

Objective: To determine if patients receiving chronic opioid therapy can be tapered to lower opioid doses without a subsequent increase in pain. Design: Retrospective and prospective chart review at a VA Medical Center. Methods: Patients were included in the review if they were prescribed opioids chronically for at least 90 consecutive days and if a plan to taper opioid doses was agreed upon. Patients 89 years of age and older, patients with cancer, and patients exhibiting aberrant behavior were excluded. The primary endpoint was to determine the percent reduction of morphine equivalents (ME) over a 12-month period. Secondary endpoints included percent reduction of ME at 3 and 6 months, change in pain perception at 3, 6, and 12 months, and change in the number of adjuvant medications prescribed at 3, 6, and 12 months. Data were analyzed utilizing descriptive statistics. Results: A total of 50 patient charts were included in the study. The average percent reduction of opioid doses was 46% over a 12-month period. Seventy percent of patients either experienced no change in pain or had less pain when comparing baseline to 12 months. An equal percentage of patients either had no change in the number of adjuvant medications prescribed or had more adjuvant medications prescribed when comparing baseline to 12 months. Conclusions: Patients in the population studied can be successfully tapered to lower opioid doses and may not necessarily experience more pain.