Identifying opioid dose reductions and discontinuation among patients with chronic opioid therapy. Issue 3 (26th August 2020)

• Record Type: Journal Article
• Authors: Hallvik, Sara E.; Johnston, Kirbee; Geddes, Jonah; Leichtling, Gillian; Korthuis, P. Todd; Hartung, Daniel M.
• Is Part Of: Pharmacoepidemiology and drug safety. Volume 30:Issue 3(2021)
• Page Start: 395
• Page End: 399
• Publication Date: 2020-08-26
• Subjects: discontinuation -- dose reduction -- opioids -- pharmacoepidemiology; Pharmacoepidemiology -- Periodicals; Chemotherapy -- Periodicals; Epidemiology -- Periodicals; 615.705
• DOI: 10.1002/pds.5096
• Languages: English
• ISSNs: 1053-8569

Abstract

Abstract: Purpose: To identify and systematically categorize opioid dose reductions and discontinuations in large administrative datasets. Methods: Using a dataset of Oregon Medicaid beneficiaries linked with prescription drug monitoring program (PDMP) data between 2014 and 2017, we identified patients with high‐dose chronic opioid therapy (COT), ≥84 consecutive days with an average daily MME of ≥50 on each of those days. We categorized patients into four mutually exclusive groups based on the trajectory of opioid use in the year after COT: abrupt discontinuation, dose reduction and discontinuation, dose reduction without discontinuation, and stable or increasing dose. Finally, we examined prescription patterns in each category. Results: Among individuals with high‐dose COT, 7636 (37.1%) had an abrupt discontinuation, 2577 (12.5%) had a dose reduction and discontinuation, 7739 (37.6%) had a dose reduction without discontinuation, and 2623 (12.8%) had a stable or increasing dose in the year following the COT episode. Among those who discontinued opioid use (n = 10 213, 49.6%), three in four (74.8%) did so without evidence of tapering. Patients who discontinued opioid use were younger, had higher daily MME during COT, and were more likely to have filled a benzodiazepine or had a multiple provider or multiple pharmacy episode compared to patients who did not discontinue opioid use. Conclusions: Dose reductions and discontinuations after a COT episode can be identified in large administrative datasets. Those with a discontinuation were more likely to have riskier prescription profiles during their COT episode.