I hear skepticism all the time about the difficulty of weaning patients off of high doses of opioids in the outpatient environment. Frankly, I hear skepticism about being able to wean them at all, but especially in the outpatient environment. And when the alternative involves inpatient detox (and its associated price tag), the claim handler often feels stuck.
New research suggests that not only is outpatient weaning possible, even in light of extremely high doses of opioids, but that the weaning has a positive clinical effect on the patient in terms of pain scores, depression levels, and activities of daily living.
In an admittedly small sample (16 patients), doctors weaned patients on an average of 945 mg morphine equivalent dosage - or MED (with a range of 300 mg MED to 2,960 MED) down to an average of 275 mg MED (with a range of 0-750 mg MED) over an average of 17.4 weeks.
The patients' average pain scores (measured via the Brief Pain Inventory) dropped from 7.2 to 4.9 and their average depression score (measured via the Patient Health Questionnaire-9) dropped from 13.5 to 9.5. The results were statistically significant.
The next step is clearly to replicate the research on a broader set of patients. That said, this research confirms what we're seeing at PRIUM among the legacy claim work comp population on high doses of opioids.
We can wean these patients. We can do it on an outpatient basis. They will get better as a result. They will cost less as a result.
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