This story tackles a study that rounded up dozens of small studies to probe the effectiveness of painkiller “tapering:” a slow, gradual weaning of opioid painkillers for those who are addicted to the drugs. The story is much more than that, however, as it lays out some the core issues with the U.S. opioid epidemic, which gives the study crucial context and potential meaning.
Readers are expertly walked through the study’s weaknesses as well as an important related issue: The troubles of trying to treat people for chronic pain without using opioids, and how access to such care is problematic. One quibble, though: We think the story could have provided more numerical data on the studies themselves.
Finding better strategies to help wean people off opioid drugs is critical, so any method (especially a cheap and effective one) could help turn the tide as researchers find and introduce effective alternatives to opioid prescription drugs.
Tapering is presumably free in and of itself, since it’s a slow and gradual lessening of opioids (which a person might already be using to begin with), so we’ll mark this N/A. However, it would require medical oversight and perhaps other alternative pain treatments, both of which aren’t free.
We’re told that with tapering, based on the literature review, “patients on average saw improved pain, function, and quality of life.” But what do those terms mean, exactly, and how much of an improvement on those criteria — numbers-wise — are we talking about here? Readers aren’t told. Some numbers would have helped readers make more sense of what “improved” means.
The harms are addressed right away: Come off opioids too quickly, and patients can suffer by having little recourse to deal with chronic pain. Some even resort to illicit drugs or commit suicide. One of the study’s authors is also quoted as recommending doctors and patients to exercise caution if tapering is being attempted, and another explains that not all patients respond the same way (and do poorly with tapering).
This article does a thorough job of laying out the study’s design, discussing what it found, and what its flaws might be. The author, in fact, dedicated several paragraphs to hedging the study’s conclusions by walking readers through its hang-ups, including its reliance on small studies with sometimes poor methodologies. The self-selecting nature of the subjects in those studies is also described— i.e. only those who volunteered to taper off opioids were studied, not people who didn’t want to go off opioids.
We didn’t see any gratuitous wording about the opioid epidemic or treating painkiller addiction in this story.
A refreshing number of outside experts are quoted or cited in this story, and their remarks weren’t the typical “the study was intriguing” variety. Their quotes added some helpful context, such as how long it can take doctors to wean people off opioids (“months or even years”) and how everyone responds differently to tapering — and how some do poorly with it.
This is one of the appreciable strengths of the story. It not only implies going cold-turkey as an option (and the pitfalls of that approach), but also digs into the topic of non-opioid pain-relief treatments to help patients deal with chronic pain as people they taper. We’re also told how such treatments can be too expensive/out of reach for some, even those with health insurance — either due to lacking coverage or nearby access to capable doctors and facilities.
The story delivers: It states that tapering is available, yet that it’s to be attempted with caution. Non-opioid pain-relief treatments, which are also noted by the story, are also said to be available, though out of reach for many.
While the approach of tapering itself itself isn’t new, this article explains that the review is novel in that it increases confidence in the idea of tapering as an effective — though with many caveats, since the studies used in the review were mostly of “poor” or “fair” quality.
We didn’t detect any evidence of copy-and-paste press release quotes or passages in this story.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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