Patient Perspectives on Prescription Opioid Discontinuation: Understanding and Promoting Safe Transitions

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PROJECT SUMMARY High rates of opioid-related mortality have led to clinical and governmental policies, including guidelines from the Centers for Disease Control and Prevention, recommending decreased use of opioids. A safety concern is that these policies have led some physicians to discontinue prescribing long-term opioid therapy (LTOT) abruptly or without support for patients, which could drive some patients to use illicit opioids or to commit suicide. Of note, rates of overdose and opioid-related deaths have not decreased significantly despite reduced use of opioids. No study to our knowledge has evaluated patient experiences when LTOT is discontinued by the prescribing provider. The proposed study addresses this critical gap in our understanding of patient and provider experiences, strategies, and decisions when faced with provider-initiated LTOT discontinuation. The study will address this gap by conducting in-depth, qualitative interviews with patients who have recently discontinued LTOT and providers who discontinued LTOT prescriptions to achieve the following aims: 1) To assess patient and provider experiences and needs when providers initiate discontinuation of LTOT; 2) To develop a patient decision aid (DA) to support patients when discontinuing LTOT; 3) To pilot test the DA with patients. The proposed study will be conducted in two states with diverse policies and prescribing environments for LTOT—Washington and Arkansas. For Aim 1, qualitative interviews will be conducted with 100 patients (50 per site) whose providers have initiated discussions that lead to LTOT discontinuation and 30 providers (15 per site) who discontinued LTOT for their patients. For Aim 2, a patient DA for discontinuing LTOT will be developed, consistent with international patient DA standards, building on findings from the Aim 1 qualitative research. Aim 3 will be a pilot test of the DA in which patients complete surveys before and after they review the DA and have a conversation about it with a study interventionist. The surveys will assess implementation feasibility, acceptability, knowledge transfer, decisional conflict, quality of the conversation generated by the DA and patient intent to follow up with their primary care provider. Public Health Impact. With prescribers now encouraged to stop prescribing opioids, impacts to patients who have LTOT discontinued include unsafe withdrawal experiences, feeling compelled to seek out riskier sources of opioids (including deadly fentanyl), and increased risk of suicide. The proposed study addresses critical gaps in knowledge and resources to improve patient-centered care and shared decision making when LTOT is discontinued. The DA will improve patient engagement around key decisions such as speed of taper, management of withdrawal symptoms, alternative pain and symptom management, as well as OUD assessment and treatment options. In the long-term, the DA will improve safety and outcomes for patients by ensuring they get the support they need to successfully discontinue LTOT.