Faster opioid tapering associated with greater risks

Pain patients on stable, long term, higher-dose opioid prescriptions who undergo tapering have significant risk of subsequent overdose and mental health crisis, especially if tapering is done faster. This is according to a retrospective cohort study by researchers from the University of California which included 113,618 patients using data from the OptumLabs Data Warehouse from 2007 to 2019. Results were published in JAMA. Researchers included data on patients aged 18 or older who were prescribed stable, high doses of opioids for at least 12 months. Patients needed to have had at least 14 months of continuous enrollment in medical, pharmacy, and mental health coverage, and 12 months of continuous opioid prescriptions with a mean daily dose of at least 50 morphine milligram equivalents. Exclusions included cancer, hospice or palliative care, buprenorphine prescriptions, or dying during the study period. Tapering was identified if the mean daily dose was greater than or equal to 15% below the mean daily dose at baseline. Researchers also identified monthly rates of dose reductions (how quickly tapering was conducted) during follow-up months. Overdose or withdrawal events “were defined as emergency department visits or inpatient hospital admissions for any drug overdose, alcohol intoxication, or drug withdrawal.” Mental health crises were identified and included emergency department visits or hospital admissions for anxiety, depression or suicide attempts. A total of 29,101 patients (54.3% female, mean age 57.7 years) underwent tapering while 84,517 (53.2% female, 58.3 years) did not undergo tapering. Tapered patients had been prescribed significantly higher baseline opioid doses. Overall, the study showed 68% more overdose events and double the number of mental health crises among tapered patients than non-tapered patients. They had greater rates of depression, anxiety and suicide attempts. Generally, the risks seen from tapering were greater in patients who had faster dose reductions and higher baseline doses of opioids. The researchers reported that post-tapering patient periods were associated with an adjusted incidence rate of 9.3 overdose events per 100 person-years compared to 5.5 events per 100 person-years in non-tapered periods. Tapering was associated with an adjusted incidence rate of 7.6 mental health crisis events per 100 person-years compared to 3.3 events per 100 person-years among non-tapered periods. “These findings suggest that adverse events associated with tapering may be relatively common and support HHS (Human Health Services) recommendations for more gradual dose reductions when feasible and careful monitoring for withdrawal, substance use, and psychological distress,” they wrote. SOURCE: https://jamanetwork.com/journals/jama/fullarticle/2782643?guestAccessKey=a13d0857-892c-4c51-b888-0412f36c9640&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=080321

Faster opioid tapering associated with greater risks

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