Two-Phase Inpatient Withdrawal Programme for Long-Term Opioid Use in Non-Cancer Pain

Area of Science:

• Pain Medicine
• Addiction Psychiatry
• Clinical Psychology

Background:

• High-dose, long-term opioid therapy for chronic non-cancer pain (CNCP) presents a growing public health challenge.
• Opioid tapering and withdrawal in CNCP patients are complex and often unsuccessful in outpatient settings.

Purpose of the Study:

• To evaluate a structured, two-phase inpatient opioid withdrawal (OW) program for CNCP patients who failed previous outpatient attempts.
• To assess the safety and efficacy of this program in achieving sustained opioid cessation.

Main Methods:

• A prospective observational study involving 38 CNCP patients on long-term opioid therapy (≥6 months, ≥100 mg MED daily).
• The program included an inpatient withdrawal phase (Phase 1) followed by multimodal pain rehabilitation (Phase 2).
• Outcomes measured were opioid abstinence rates (primary) and pain intensity changes (secondary).

Main Results:

• 89% of patients completed both phases; 84% were opioid-free post-Phase 2.
• At 3 months, 61% remained opioid-free, with stable median pain intensity.
• One patient died by suicide 10 days post-withdrawal; other adverse events were not detailed.

Conclusions:

• The two-phase inpatient program effectively facilitated opioid discontinuation in CNCP patients without increasing pain.
• A significant majority achieved sustained opioid abstinence at 3 months, underscoring the program's success.
• Careful patient selection and ongoing psychological support are crucial for optimizing opioid withdrawal outcomes.