Dose tapering, increases, and discontinuity among patients on long-term high-dose opioid therapy in the United States, 2017–2019
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Dose tapering, increases, and discontinuity among patients on long-term high-dose opioid therapy in the United States, 2017–2019

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English
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Details:

  • Alternative Title:
    Drug Alcohol Depend
  • Personal Author:
  • Description:
    Background:

    While reduced exposure to prescription opioids may decrease risks, including overdose and opioid use disorder, abrupt tapering or discontinuation may pose new risks.

    Objectives:

    To examine potentially unsafe tapering and discontinuation among dosage changes in opioid prescriptions dispensed to US patients on high-dose long-term opioid therapy.

    Design:

    Longitudinal observational study of adults (≥18 years) on stable high-dose (≥50 oral morphine milligram equivalents [MME] daily dosage) long-term opioid therapy during a 180-day baseline and a 360-day follow-up using all-payer pharmaceutical claims data, 2017–2019.

    Measures:

    Dosage tapering, increases, and/or stability during follow-up; sustained dosage stability, reductions, or discontinuation at the end of follow-up; and tapering rate. Patients could experience more than one outcome during follow-up.

    Results:

    Among 595,078 patients receiving high-dose long-term opioid therapy in the sample, 26.7% experienced sustained dosage reductions and 9.3% experienced discontinuation. Among patients experiencing tapering, 62.0% experienced maximum taper rates between > 10–40% reductions per month and 36.1% experienced monthly rates ≥ 40%. Among patients with mean baseline daily dosages ≥ 150 MME, 47.7% experienced a maximum taper rate ≥ 40% per month. Relative to baseline, 19.7% of patients experiencing tapering had long-term dosage reductions ≥ 40% per month at the end of follow-up.

    Implications:

    Dosage changes for patients on high-dose long-term opioid therapy may warrant special attention, particularly over shorter intervals, to understand how potentially sudden tapering and discontinuation can be reduced while emphasizing patient safety and shared decision-making. Rapid discontinuation of opioids can increase risk of adverse outcomes including opioid withdrawal.

  • Subjects:
  • Source:
    Drug Alcohol Depend. 234:109392
  • Pubmed ID:
    35287033
  • Pubmed Central ID:
    PMC9635453
  • Document Type:
    Journal Article
  • Funding:
    CC999999/ImCDC/Intramural CDC HHSUnited States/
  • Collection(s):
  • Main Document Checksum:
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  • File Type:

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