Multicomponent Intervention to Reduce Opioid Pain Medication Dosage May Be Effective Among People Interested in Tapering or Cessation

This multicenter, randomized clinical trial tested whether a multicomponent, group-based, self-management intervention could help adults with chronic, non-cancer pain prescribed high doses of opioid medications (N=608; median daily dosage of ~45 morphine milligram equivalent [MME]) reduce their opioid dose and improve pain-related disability. The intervention included 3 day-long group sessions, individual consultation with a nurse, and an individualized opioid tapering plan, while the comparison group received usual care. Both groups received a self-help booklet and relaxation CD. Researchers assessed participants’ opioid use, pain interference, pain intensity, withdrawal, depression, anxiety, and quality of life at 4, 8, and 12 months.

• At 12 months, compared with those receiving usual care, more intervention group participants completely discontinued opioid medications (7 versus 29 percent, respectively), and reduced opioid medication dosage by more than half from their baseline dose (27 versus 57 percent).
• 42 of 90 participants who fully discontinued opioid medications were receiving <30 MME at baseline.
• Pain scores were not significantly different between groups at any follow-up time-point.
• There were very serious adverse events (experienced by 8 percent of patients in the intervention group, and 5 percent in the control group); one participant in the intervention arm was hospitalized due to a suicide attempt.

Comments: This study provides more evidence that patients receiving high doses of opioid medications for chronic, non-cancer pain who want to taper or stop their medication can do so with education and support. However, clinicians must not extrapolate findings to patients who choose not to taper opioid medications. Due to the association between opioid medication dose and the risk of overdose or developing substance use disorder, voluntary tapers could also improve these outcomes. Importantly, worsening mental health and suicidality remain concerns during and following opioid medication tapers.

Aaron D. Fox, MD

Reference: Sandhu HK, Booth K, Furlan AD, et al. Reducing opioid use for chronic pain with a group-based intervention: a randomized clinical trial. JAMA. 2023;329(20):1745–1756.