New Haven, CT—While opioid painkillers prescribed for chronic pain can increase patients’ risk of death, adhering to clinical practice guidelines can help mitigate that effect, according to a new study.

The report, published in the Journal of General Internal Medicine, suggests that guidelines encouraging physicians to engage patients with mental health services and substance abuse treatment, as well as to avoid co-prescriptions for sedatives, are especially effective.

Yale University–led researchers investigated how “guideline-concordant" care—involving patient monitoring, testing, and multidisciplinary care, such as mental health services, substance abuse treatment, and physical rehabilitation—affects the risks of long-term opioid therapy (LtOT) for pain. To do so, they analyzed records of more than 17,000 Veterans Affairs patients who initiated opioid therapy between 2000 and 2010, assessing outcomes a year later.

Results indicate that while more than 1,000, or 6%, of patients had died, guideline-concordant care appeared to have helped avoid those consequences.

“Those who received mental health services, substance abuse treatment, and physical rehabilitation were less likely to die within the first six months of starting opioids,” said first author Julie R. Gaither, RN, MPH, postdoctoral fellow at Yale School of Medicine. “Patients who received mental health care were 50% less likely to die.”

On the other hand, patients prescribed benzodiazepines in addition to opioids were about 1.5 times more likely to die, and patients who did not receive treatment for substance abuse disorder (SUD) were 2.5 times more likely to die.

No difference in mortality was identified for patients who received recommended follow-up visits or urine drug testing.

“Providers should use caution in initiating LtOT in conjunction with benzodiazepines and untreated SUDs,” the authors write. “Patients receiving LtOT may benefit from multi-modal treatment that addresses chronic pain and its associated comorbidities across multiple disciplines.

"Patients who receive care that is closer to what is recommended by the guidelines do better and are less likely to die," Gaither added in a Yale press release.

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