Identifying opioid dose reductions and discontinuation among patients with chronic opioid therapy

Details

• Alternative Title:
  Pharmacoepidemiol Drug Saf
• Personal Author:
  Hallvik, Sara E. ; Johnston, Kirbee ; Geddes, Jonah ; Leichtling, Gillian ; Korthuis, P. Todd ; Hartung, Daniel M.
• Description:
  Purpose:
  
  To identify and systematically categorize opioid dose reductions and discontinuations in large administrative datasets.
  
  Methods:
  
  Using a dataset of Oregon Medicaid beneficiaries linked with prescription drug monitoring program (PDMP) data between 2014 and 2017, we identified patients with high-dose chronic opioid therapy (COT), ≥84 consecutive days with an average daily MME of ≥50 on each of those days. We categorized patients into four mutually exclusive groups based on the trajectory of opioid use in the year after COT: abrupt discontinuation, dose reduction and discontinuation, dose reduction without discontinuation, and stable or increasing dose. Finally, we examined prescription patterns in each category.
  
  Results:
  
  Among individuals with high-dose COT, 7636 (37.1%) had an abrupt discontinuation, 2577 (12.5%) had a dose reduction and discontinuation, 7739 (37.6%) had a dose reduction without discontinuation, and 2623 (12.8%) had a stable or increasing dose in the year following the COT episode. Among those who discontinued opioid use (n = 10 213, 49.6%), three in four (74.8%) did so without evidence of tapering. Patients who discontinued opioid use were younger, had higher daily MME during COT, and were more likely to have filled a benzodiazepine or had a multiple provider or multiple pharmacy episode compared to patients who did not discontinue opioid use.
  
  Conclusions:
  
  Dose reductions and discontinuations after a COT episode can be identified in large administrative datasets. Those with a discontinuation were more likely to have riskier prescription profiles during their COT episode.
  
  
• Subjects:
  Analgesics, Opioid Article Discontinuation Dose Reduction Drug Tapering Humans Medicaid Opioid-Related Disorders Opioids Pharmacoepidemiology Prescription Drug Monitoring Programs United States

  More +
• Source:
  Pharmacoepidemiol Drug Saf. 30(3):395-399
• Pubmed ID:
  32844498
• Pubmed Central ID:
  PMC8213356
• Document Type:
  Journal Article
• Funding:
  U01CE002786/ACL/ACL HHSUnited States/ ; CDC U01CE002786/CC/CDC HHSUnited States/
• Volume:
  30
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e046d2fc256a44c15c1186c8752d5d747338b3d568202336ff997511a6c04110
• Download URL:
  https://stacks.cdc.gov/view/cdc/107386/cdc_107386_DS1.pdf
• File Type:
  [PDF - 199.81 KB ]