For years, pain patient activists have been sounding the alarm about the consequences of abruptly halting people’s access to opioid analgesics, supported by much research. A new addition to the body of evidence suggests that patients who have been treated the longest are at the greatest risk of fatal overdose and/or suicide after having their meds withdrawn.
The Veterans Health Administration (VHA) drastically cut its opioid prescribing in half within the first fiscal year of its 2013 Opioid Safety Initiative. In that time year, 2,887 patients died from suicide or overdose, a March 4 study found.
The study authors found a “significant interaction between stopping treatment with opioids and length of treatment.” The biggest proportion of veteran patients whose medication was ended had been on treatment for more than 400 days, the largest time period category—and they also faced the highest risk of death. The researchers also found an association between the deaths and having a substance use disorder or other mental illness. The risk of suicide and fatal overdose was also pronounced during the first months of treatment.
The fatal potential of being cut off from pain treatment is far from a new discovery. The VHA itself advises that “[a]brupt discontinuation should be avoided unless required for immediate safety concerns.” The Food and Drug Administration has flat out rejected sudden termination of opioids, instead recommending the use of “a patient-specific plan to gradually taper the dose of the opioid and ensure ongoing monitoring and support.”
There’s evidence to suggest that the VHA was not doing everything it could to prevent these deaths. While the VHA began issuing naloxone to veteran patients in 2014 to stem overdoses, the VHA in fact had a predictive model designed to estimate a patient’s risk of experiencing a “serious adverse event,” specifically meaning an overdose or suicide attempt—yet doctors were not providing required interventions for the most high-risk patients between at least 2016 and 2017.
Out of 25 highest-risk veteran patient cases studied by the Government Accountability Office (GAO) in 2018, only five of the patience received an annual Prescription Drug Monitoring Program search and just 11 provided with informed consent about risks associated with being prescribed opioids.
“To the extent that these factors affect all VHA facilities,” stated the GAO report, “VHA will continue to face challenges ensuring that its providers prescribe opioids in a safe and effective manner.”