Yale researchers develop method to reduce opioid use without side-effects/withdrawal

Clinician-researchers at Yale School of Medicine have developed a new method for patients using opioids for long-term pain therapy to reduce their opioid usage without suffering through withdrawal or unwanted side effects.

By combining buprenorphine therapy with opioid therapy, researchers found they could successfully phase out the use of oxycodone and morphine in patients. Buprenorphine is a well-established treatment for opioid use disorder. Over time, the patients are shifted to buprenorphine solely to improve their quality of life.

The study looked at six patients over the age of 55. Those findings allowed the researchers to modify and existing multi-site $12 million study funded by the Patients-Centered Outcomes Research Institute to include this new treatment method, as well as another by the National Institutes of Health that will start enrolling patients in September.

“For patients, this is a potential game-changer,” said Dr. William C. Becker, associate professor in internal medicine at Yale School of Medicine. “For patients on long-term opioids, the fear of withdrawal symptoms is hugely daunting and often prevents them from making needed changes.”

The method was first used on a 62-year-old man who was on oxycodone to treat chronic lower back pain from degenerative disk disease. The patient reported being “in a rut,” and despite high doses of the drug, his pain remained intense. The patient also reported that the drug was impairing his mental acuity. However, lowering the dose of the drug resulted in insomnia.

Clinicians decided to overlap his oxycodone therapy with buprenorphine therapy to transition him from one drug to the other. After a month, the patient reported feeling “overall better, clearer.” While his pain intensity didn’t change, his ability to work more productively went up.

Becker said a similar technique is used in treating heroin-addicted patients.

None of the six cases in the study experienced withdrawal symptoms, and almost all saw a reduction in side-effects like sleepiness and grogginess. Some, the study found, also experienced a reduction in pain.

“Buprenorphine is markedly safer and reduces the risk of overdoses,” he said. “Many patients 60 and older on opioids for back pain and other chronic pain issues have been taking them since they were in their 40s. Now they are on super high doses, and if they even think about tapering, they panic. Buprenorphine offers them a way out.”

The report appears in the April 6 edition of the Annals of Internal Medicine.

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