“Legacy” opioid patients are common in pain management practices. They are considered patients who have been on high-dose opioids for prolonged periods of time. New, painful conditions may develop over time due to the high levels of opioid consumption. These “legacy” patients must be reevaluated routinely to prevent the negative effects of long-term opioid use.
Use of long-term opioid therapy for chronic pain has increased dramatically1 and often has negative impacts including an increased risk of overdose. This long-term opioid use for chronic pain is not recommended by Pain Management Professionals or the CDC. Federal regulations are addressing over-prescribing and placing limits on daily doses to help prevent overdoses. This leaves chronic pain patients and their providers in a difficult position to stay compliant and still do what is best for the patient.
Negative impact of long-term opioid therapy
The patient’s health is the priority. Opioid prescribing should be managed because prolonged use of opioids for pain management can produce a myriad of negative health effects for “legacy” patients including:2
- Gastrointestinal system effects, such as constipation, which is associated with significant economic consequences and quality of life burden
- Respiratory system effects, such as sleep-disordered breathing
- Respiratory system depression, bradycardia, and hypotension
- Major Adverse Cardiovascular Events (MACE), such as myocardial infarction and heart failure
- Central nervous system effects, such as dizziness and sedation
- Decreased cognition, memory loss, and risk of dementia especially in elderly patients
- Increased risk of fractures
- Other immune and endocrine system effects
- Addiction and overdose risk
To reduce the adverse effects of long-term opioid use, providers often need to rapidly taper patients off opioids. This process can be a challenging and risky endeavor for providers and can lead to acute withdrawal symptoms, exacerbation of pain, serious psychological distress, and suicidal ideation.3 If a taper is to avoid these events, it could take years to slowly reduce the dosages.
A critical component of an opioid tapering strategy
Opioid tapering is a time consuming and challenging process, and often involves patients being:
- Weaned completely off opioid medications,
- Rotated to other opioid classes such as methadone, or
- Transitioned to other alternative treatments such as psychological therapy, NMDA receptor agonists (dextromethorphan and ketamine),4 and neurostimulation devices such as S.T. Genesis.
Providers can reduce or eliminate long-term opioid use health risks through a comprehensive clinical care management program to taper opioid use which can include the use of the S.T. Genesis device to manage withdrawal symptoms. The FDA-cleared device supports the reduction of opioid withdrawal symptoms by targeting the areas of the brain responsible for pain and anxiety. The noninvasive, drug-free device is easily applied to the ear by any provider and administers treatment for 5 days helping the patient during the most critical time as they reduce opioid use. The device has proven clinical efficacy in reducing opioid withdrawal symptoms by up to 93% within the first hour, most occurring within 15 minutes. For “legacy” patients, S.T. Genesis can help to reduce or eliminate opioid dosages immediately.
- https://effectivehealthcare.ahrq.gov/products/chronic-pain-opioid-treatment/research
- Baldini A, Von Korff M, Lin EH. A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide. Prim Care Companion CNS Disord. 2012;14(3):PCC.11m01326. doi:10.4088/PCC.11m01326
- https://www.hhs.gov/opioids/treatment/clinicians-guide-opioid-dosage-reduction/
- Peter Yi, MD, Peter Pryzbylkowski, MD, Opioid Induced Hyperalgesia, Pain Medicine, Volume 16, Issue suppl_1, October 2015, Pages S32–S36, https://doi.org/10.1111/pme.12914