Opioid dose tapering on the rise

  • Fenton JJ & al.
  • JAMA Netw Open
  • 01.11.2019

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • The number of long-term opioid users undergoing dose tapering more than doubled between 2008 and 2017, with women and patients taking higher doses the most likely to taper.

Why this matters

  • Nearly 20% of those who tapered their opioid dose had a maximum dose reduction rate higher than the recommended 10% decrease per week to minimize withdrawal symptoms.

Study design

  • Retrospective cohort study of patients (n=100,031) with commercial/Medicare Advantage insurance receiving long-term opioids.
  • Rate of opioid dose tapering was analyzed (≥15% relative reduction in mean daily morphine milligram equivalents [MMEs]).
  • Funding: University of California-OptumLabs Research Credit; Department of Family and Community Medicine.

Key results

  • Patients had 174,822 periods of stable baseline dosing (2008-2017).
  • The percentage prescribed long-term opioids undergoing dose tapering increased from 2008-2015 (10.5%-13.7%) to 2015-2017 (16.2%-22.4%).
  • The adjusted incidence rate ratio (aIRR) in 2016-2017 vs 2008-2015 was 1.20 (P<.001>
  • Patient-level factors associated with long-term opioid dose tapering:
    • female sex (aIRR, 1.13; P<.001 and>
    • higher baseline dose (≥300 MMEs/day vs 50-89 MMEs/day; aIRR, 2.57; P<.001>
  • The maximum rate of dose tapering was 27.6% (17.0%) per month.
  • 18.8% of the patients had a maximum tapering rate exceeding 40% per month.

Limitations

  • Limited generalizability of findings.

Coauthored with Chitra Ravi, MPharm