Undoing the harm: Tapering down from high-dose opioids

For many years, health care providers like me were told that we were undertreating pain and that pain was a vital sign that needed to be measured. Concurrently, we were reassured that opioids were a safe and effective way to treat pain, with very little potential for development of abuse. As a result, opioid prescriptions in the United States skyrocketed. A common way to compare opioids is to calculate their strength relative to morphine, called morphine milligram equivalents, or MMEs. In 1992, our country dispensed 25 billion MMEs of prescription opioids; by 2011, that number had reached 242 billion. Meanwhile, opioid-related deaths and treatment admissions increased in parallel. Over the past several years, we have come to recognize that high doses of opioids for patients with chronic, non-cancer pain can be extremely dangerous. Furthermore, there is increasing evidence that long-term opioid therapy is not very efficacious. Multiple studies culminated in the Centers for Disease Control and Prevention (CDC)’s 2016 Guideline for Prescribing Opioids for Chronic Pain, which states that providers “should avoid increasing dosage to 90 MME or more per day or carefully justify a decision to titrate dosage to 90 MME or more per day.” As a point of reference, a commonly prescribed opioid is oxycodone, the medicine in the brand name Percocet. A 5-mg dose of oxycodone equals 7.5 MMEs, so you would reach the 90 MME threshold by taking 12 or more of these pills per day. The guideli...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Addiction Pain Management Risks and Prevention Source Type: blogs