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Rapid opioid cutoff is risky too, feds warn

Christine Vestal, Stateline.org on

Published in News & Features

WASHINGTON -- To stem the opioid epidemic, U.S. doctors cut prescriptions of medications such as OxyContin, Vicodin and Percocet by at least a quarter over the last five years. But the reduction in prescriptions came at a cost to some pain patients.

The U.S. Centers for Disease Control and Prevention and the Food and Drug Administration last month warned prescribers that abruptly cutting off high-dose patients or tapering their doses too rapidly could cause withdrawal and even suicide.

The new recommendations likely will prompt states to consider adjusting their opioid prescribing laws, said Karmen Hanson, a public health expert at the National Conference of State Legislatures. But since the CDC and FDA clarifications came near the end of legislative sessions for most states, no actions are anticipated this year, she said.

More than half of states enacted laws restricting painkiller prescriptions after earlier federal guidance urged such limits, but the agencies say that advice may have been misinterpreted or taken too far.

The FDA last month said it had received reports of patients taken off their pain medicines who were suffering "serious withdrawal symptoms, uncontrolled pain, psychological distress and suicide."

Likewise, the CDC -- which in 2016 recommended prescribing limits for opioid painkillers -- said it had received reports that some prescribers were too rigidly adhering to its dosage guidelines and had misapplied the limits to patients already on high doses of opioids.

 

In its 2016 guidelines, the CDC urged doctors to use opioid painkillers sparingly, and instead opt for non-opioid medications and non-pharmacological solutions to pain, such as physical therapy.

The agency recommended a one-week limit on the number of pills prescribed for first-time users suffering from acute pain and urged doctors to avoid increasing longer-term prescriptions for chronic pain to more than the equivalent of 90 mg of morphine a day.

Last month, the agency said: "This statement does not address or suggest discontinuation of opioids already prescribed at higher dosages, yet it has been used to justify abruptly stopping opioid prescriptions or coverage."

The recommended limit of 90 mg equivalents is roughly equal to two tablets of 30 mg OxyContin or nine tablets of 10 mg Vicodin, a medication level that the agency says should be reserved for cancer patients, patients at the end of life, and others with intractable pain.

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