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

Details

• Alternative Title:
  Drug Alcohol Depend
• Personal Author:
  Nataraj, Nisha ; Strahan, Andrea E. ; Guy, Gery P. ; Losby, Jan L. ; Dowell, Deborah
• 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:
  Adult Analgesics, Opioid Article Discontinuation Drug Overdose Drug Tapering Humans Long-term Opioid Therapy Opioid-Related Disorders Prescription Opioids Retrospective Studies Tapering United States

  More +
• Source:
  Drug Alcohol Depend. 234:109392
• Pubmed ID:
  35287033
• Pubmed Central ID:
  PMC9635453
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  234
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:673f0732cb9a297fd1d0784ac43aaddac2744be45447f6b4217e1418eeac6474
• Download URL:
  https://stacks.cdc.gov/view/cdc/122062/cdc_122062_DS1.pdf
• File Type:
  [PDF - 503.87 KB ]