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Scandinavian Journal of Pain

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

Kehua Zhou
  • Corresponding author
  • Catholic Health System Internal Medicine Training Program, Sisters of Charity Hospital, University at Buffalo, 2157 Main Street, Buffalo, NY 14214Buffalo, United States
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/ Peng Jia
  • Faculty of Geo-information Science and Earth Observation (ITC), University of Twente, Enschede 7500, Enschede The Netherlands
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/ Swati Bhargava
  • Catholic Health System Internal Medicine Training Program, Sisters of Charity Hospital, University at Buffalo, 2157 Main Street, Buffalo, NY 14214Buffalo, United States
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/ Yong Zhang / Taslima Reza
  • Academic Buffalonias in Physical Medicine and Rehabilitation, 2121 Main St #210, Buffalo, NY 14214, Buffalo United States
  • Avalon University School of Medicine, Youngstown, OH, United States
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/ Yuan Bo Peng
  • Department of Psychology, University of Texas at Arlington, 501 S Nedderman Dr., Arlington, TX 76019-0528, Nedderman United States
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/ Gary G. Wang
  • Corresponding author
  • Catholic Health System Internal Medicine Training Program, Sisters of Charity Hospital, University at Buffalo, 2157 Main Street, Buffalo, NY 14214Buffalo, United States
  • Academic Buffalonias in Physical Medicine and Rehabilitation, 2121 Main St #210, Buffalo, NY 14214, Buffalo United States
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-12-29 | DOI: https://doi.org/10.1016/j.sjpain.2017.09.005

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.

Keywords: Opioid use disorder; Chronic non-cancer pain; Medication assisted treatment; Methadone

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About the article

Catholic Health System Internal Medicine Training Program, Sisters of Charity Hospital, University at Buffalo, 2157 Main Street, Buffalo, NY 14214, United States

Academic Buffalonias in Physical Medicine and Rehabilitation, 2121 Main Street, Suite 210, Buffalo, NY 14214, United States


Received: 2017-09-04

Revised: 2017-09-06

Accepted: 2017-09-09

Published Online: 2017-12-29


Conflicts of interest: The authors report no conflicts of interest.


Citation Information: Scandinavian Journal of Pain, Volume 17, Issue 1, Pages 167–173, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.09.005.

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© 2017 Scandinavian Association for the Study of Pain. Copyright Clearance Center

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