Long-term opioid therapy tapering: Trends from 2014 to 2018 in a Midwestern State. (1st November 2021)

• Record Type: Journal Article
• Authors: Mazurenko, Olena; Gupta, Sumedha; Blackburn, Justin; Simon, Kosali; Harle, Christopher A.
• Is Part Of: Drug and alcohol dependence. Volume 228(2021)
• Publication Date: 2021-11-01
• Subjects: Long-term opioid therapy -- Chronic pain, opioids, tapering -- CDC guideline; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2021.109108
• Languages: English
• ISSNs: 0376-8716

Abstract

Abstract: Background: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain (Guideline hereafter) emphasized tapering patients from long-term opioid therapy (LTOT) when the harms outweigh the benefits. Methods: To examine tapering from LTOT before and after the Guideline release, we conducted a retrospective cohort study of adults with high-dose LTOT (mean of >50 Morphine Milligram Equivalents [MME]/day) from 2014 to 2018 from one Midwest state's Health Information Exchange. We identified tapering (dose reductions in mean MME/day greater than 15%, 30%, 50%) and rapid discontinuation episodes (reduction to zero MME/day) over a 6-month follow-up period relative to a 3-month baseline period. We used segmented regressions to estimate outcomes adjusted for time trends and relevant state laws limiting opioid prescribing. Results: The Guideline release was associated with statistically significant immediate increase in the patient likelihood of experiencing tapering ( 15%: 1.8% point [95% confidence interval (CI): 1.2–2.6; 30%: 1.4% point, 95% CI: 0.7–2.2; 50%: 0.8% point, 95% CI: 0.2–1.4) and rapid discontinuation episodes (0.006% point, 95% CI: 0.001–0.01). After the Guideline release, the patient likelihood of tapering increased over time ( 15% : 0.4% point/month, 95% CI: 0.3–0.5; 30%: 0.3% point/month, 95% CI:0.2–0.4; 50%: 0.3% point/month, 95% CI: 0.2–0.3; rapid discontinuation: 0.01% point/month, 95% CI: 0.007–0.01). Tapering and rapid discontinuation trends was similar among gender and race categories. Conclusion: The Guideline may be a useful tool in altering opioid prescribing practices, particularly for patients on shorter durations of LTOT. Highlights: Guideline release increases a patient likelihood of being tapered from LTOT. Tapering may be more pronounced in patients on shorter durations of LTOT A patient likelihood of being tapered from LTOT was similar among genders and race. Guideline may be a useful tool in altering opioid prescribing for patients on LTOT.