When Beth Darnall talks to patients about reducing their opioid medications, she often hears the same fear: What if I need them and they're gone?
It's a real concern. More than 50 million Americans live with chronic pain, and about 1 in 10 of them take prescription opioids regularly. Many have been on these medications for years.
Now, a major new study from Stanford Medicine offers reassuring news. Researchers found that many chronic pain patients can safely cut their opioid use by half or more, without making their pain worse.
The key, the study shows, is going slowly—and letting patients stay in control.
"So much of the fear of opioid tapering is about losing control," said Darnall, a professor of anesthesiology and pain medicine who led the research. "We tested a patient-centered methodology where we really focused on the individual patient and developed methods to ensure that they had maximal control in the process."
The study followed more than 500 adults who had experienced pain for at least six months and had been taking prescription opioids for at least three months. On average, participants had been on opioids for 12.4 years—more than a decade.
Each patient worked with their doctor to create a personal plan. The goal was to reach their lowest comfortable dose over 12 months. Doses were reduced by no more than 10% per month, and patients could pause or adjust the pace whenever they wanted.
After one year, about half of patients had a successful outcome: they either cut their dose by at least 50% without increased pain, or they stayed at the same dose but felt significantly better.
"For patients, I think the data are reassuring that if opioids are tapered the right way, meaning a patient-centered approach, people can significantly reduce their opioid doses without having increased pain long term," Darnall said.
The study also tested whether extra support helped. Some patients received cognitive behavioral therapy for chronic pain; others joined a peer-led self-management program. Neither added to the success rate, though therapy did seem to ease withdrawal symptoms.
This gradual approach aligns with current CDC guidelines—but that wasn't always the case. In 2016, the CDC released opioid prescribing guidelines encouraging doctors to reduce doses. Many patients were tapered too quickly, sometimes without their consent. Some experienced severe withdrawal, mental distress, or turned to dangerous street drugs.
"Ironically, in the name of reducing their risk, we were creating new risks by reducing opioids in the wrong way," Darnall said. "The data told us that there are risks when you go up on doses, but there are risks when you go down on doses, too."
The takeaway for patients: reducing opioids doesn't have to mean white-knuckling through withdrawal. With a slow, personalized plan and real control over the process, many people can find a lower dose that still works for their pain.