Patient outcomes following opioid dose reduction among patients with chronic opioid therapy

Details

• Alternative Title:
  Pain
• Personal Author:
  Hallvik, Sara E ; El Ibrahimi, Sanae ; Johnston, Kirbee ; Geddes, Jonah ; Leichtling, Gillian ; Korthuis, P. Todd ; Hartung, Daniel M.
• Description:
  The net effects of prescribing initiatives that encourage dose reductions are uncertain. We examined whether rapid dose reduction after high-dose chronic opioid therapy (COT) associates with suicide, overdose, or other opioid-related adverse events. This retrospective cohort study included Oregon Medicaid recipients with high-dose COT. Claims were linked with prescription data from the prescription drug monitoring program and death data from vital statistics, 2014 to 2017. Participants were placed into 4 mutually exclusive dose trajectory groups after the high-dose COT period, and Cox proportional hazard models were used to examine the effect of dose changes on patient outcomes in the following year. Of the 14,596 high-dose COT patients, 4191 (28.7%) abruptly discontinued opioid prescriptions, 1648 (11.3%) reduced opioid dose before discontinuing, 6480 (44.4%) had a dose reduction but never discontinued, and 2277 (15.6%) had a stable or increasing dose. Discontinuation, whether abrupt (adjusted hazard ratio [aHR] 3.63; 95% confidence interval [CI] 1.42-9.25) or with dose reduction (aHR 4.47, 95% CI 1.68-11.88) significantly increased risk of suicide compared with those with stable or increasing dose. By contrast, discontinuation or dose reduction reduced the risk of overdose compared with those with a stable or increasing dose (aHR 0.36-0.62, 95% CI 0.20-0.94). Patients with an abrupt discontinuation were more likely to overdose on heroin (vs. prescription opioids) than patients in other groups (P < 0.0001). Our study suggests that patients on COT require careful risk assessment and supportive interventions when considering opioid discontinuation or continuation at a high dose.
• Subjects:
  Analgesics, Opioid Drug Overdose Drug Tapering Humans Opioid-Related Disorders Prescription Drug Monitoring Programs Retrospective Studies United States
• Source:
  Pain. 163(1):83-90
• Pubmed ID:
  33863865
• Pubmed Central ID:
  PMC8494834
• Document Type:
  Journal Article
• Funding:
  U01 CE002786/CE/NCIPC CDC HHSUnited States/ ; U01CE002786/ACL/ACL HHSUnited States/ ; UG3 DA044831/DA/NIDA NIH HHSUnited States/ ; UG1 DA015815/DA/NIDA NIH HHSUnited States/ ; U10 DA015815/DA/NIDA NIH HHSUnited States/
• Volume:
  163
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6b99644e9f448239bcfb6386975fdae859f63c874f63ccd2b7b1642aa5037623
• Download URL:
  https://stacks.cdc.gov/view/cdc/158051/cdc_158051_DS1.pdf
• File Type:
  [PDF - 666.87 KB ]