Support programme helps chronic pain patients come off strong opioids, and may pay off for the NHS
In the I-WOTCH trial, 29% of chronic pain patients in a support programme stopped strong opioids within a year, versus 7% with usual care, and a new analysis suggests it could be good value for the NHS.
A support programme helped far more people with long-term pain stop taking strong opioid painkillers than standard care did, and a new economic analysis suggests it could be good value for England's NHS, the University of York said. The analysis of the I-WOTCH programme is published in the journal Addiction.
29% stopped strong opioids, compared with 7%
More than 600 patients with chronic pain not caused by cancer took part in the year-long trial at GP surgeries across England. After 12 months, 29% of those in the support group were off strong opioids entirely, compared with 7% of those who received usual care, without their health-related quality of life getting worse.
The programme combined a three-day group course, led by a trained nurse and a person with lived experience of cutting down opioids, with two nurse appointments and follow-up phone calls, according to the University of Warwick, which ran the trial. The main trial results were published in JAMA in 2023.
“Strong opioids, even when used in the prescribed dosage by a medical professional, can cause dependency and without structured support some people can struggle to cut them down or stop altogether.” — Professor Cynthia Iglesias, University of York
Higher costs at first, savings later
The economic analysis found the programme raises healthcare costs in the first year, as patients need extra support while tapering, but its longer-term benefits mean it could be cost-effective. Iglesias said it could support NHS efforts to reduce strong-opioid prescribing.
Why long-term opioid use is a concern
Strong opioids work well for short-term pain, but there is little evidence they help long-term pain not caused by cancer, and continued use carries risks including dizziness, falls, sleep apnoea, overdose and early death. In 2019, 5.6 million people in England collected an opioid prescription. NICE guidance recommends tapering or stopping when risks outweigh benefits.
The researchers now want to follow patients for longer to see whether the habits last.
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