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

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

Authors :
Nataraj N
Strahan AE
Guy GP Jr
Losby JL
Dowell D
Source :
Drug and alcohol dependence [Drug Alcohol Depend] 2022 May 01; Vol. 234, pp. 109392. Date of Electronic Publication: 2022 Mar 03.
Publication Year :
2022

Abstract

Background: While reduced exposure to prescription opioids may decrease risks, including overdose and opioid use disorder, abrupt tapering or discontinuation may pose new risks.<br />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.<br />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.<br />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.<br />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.<br />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.<br /> (Published by Elsevier B.V.)

Details

Language :
English
ISSN :
1879-0046
Volume :
234
Database :
MEDLINE
Journal :
Drug and alcohol dependence
Publication Type :
Academic Journal
Accession number :
35287033
Full Text :
https://doi.org/10.1016/j.drugalcdep.2022.109392