Primary care taper plans associated with sustained opioid reduction

  • D Sullivan M & al.
  • J Gen Intern Med
  • 06.01.2020

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Sustained opioid reduction in chronic pain patients with higher-dose, long-term opioid therapy was almost 4 times more likely if their general practitioners (GPs) developed and documented an opioid taper plan.
  • Taper plans that included behavioral health visits, receipt of gabapentin/pregabalin, and antidepressants or antianxiety medication were more likely to succeed.

Why this matters

  • Data on the effectiveness of taper plans in primary care practice are lacking.
  • Evidence suggests that GPs may be reluctant to implement such plans.
  • In some EU countries, opioid prescribing patterns are shifting.

Study design

  • Nested case-control study (sustained opioid taper, n=894; without sustained taper/controls, n=3576).
  • Funding: Purdue Pharma.

Key results

  • Sustained taper:
    • Average daily opioid dose of ≤30 mg morphine equivalent (MME; with discontinuation as a special case); and/or
    • At least a 50% reduction in MME from the patient’s nearest peak opioid average dose.
  • A significant association between opioid taper plan and sustained taper was noted: OR, 3.63 (P<.0001>
  • Taper plans associated with sustained taper (Pboth<.0001 style="list-style-type:circle;">
  • Taper plans from prescription instructions: aOR, 4.03; and
  • Taper plans from clinical encounter notes: aOR, 2.82.

Limitations

  • Data on medications outside this specific clinical system are unknown.

Coauthored with Chitra Ravi, MPharm