CHPR Researchers Identify Risks Associated with Tapering Opioid Dose for Patients Prescribed Long-term Opioids
A team of researchers affiliated with the UC Davis Center for Healthcare Policy and Research (CHPR) has completed an assessment of whether opioid dose tapering among patients prescribed stable, long-term, high-dose opioids is associated with risks of subsequent overdose or mental health crisis. The team, led by Alicia Agnoli, M.D., M.P.H., M.H.S., published their results in the August 3rd issue of JAMA.
In response to the ongoing opioid crisis in the United States, federal agencies such as the Centers for Disease Control and Prevention (CDC, 2016) had previously recommended both against using higher doses of opioids to manage chronic pain and for dose tapering when harms of continued therapy outweigh perceived benefits for individual patients. But a few studies since have suggested that tapering, in certain circumstances, could trigger unhealthy substance use, depression, anxiety, or have other negative effects and subsequent U.S. recommendations have advised caution in opioid de-prescribing.
To get a clearer picture of the potential risks associated with tapering opioids, Dr. Agnoli and her team of UC Davis colleagues conducted a retrospective cohort study of de-identified data from 113,618 patients prescribed stable, high-dose, long-term (for at least 12 months) opioids. They compared patients who had had their doses tapered (reduced by at least 15%) with patients before or without tapering and found that risks of both suffering an overdose and experiencing a mental health crisis were significantly higher for the group of patients whose doses had been tapered.
The authors note that limitations of their study include the nature of the administrative data analyzed and its observational study design; nevertheless, the study findings raise questions about potential harms of tapering. An editorial in the same issue of JAMA, “Opioid Tapering Practices—Time for Reconsideration?,” considers these potential harms further.
Dr. Agnoli and co-authors of the JAMA paper Elizabeth Magnan, Anthony Jerant, and Joshua Fenton are all faculty members in the UC Davis Department of Family and Community Medicine, while co-author Daniel Tancredi is a faculty member in the Department of Pediatrics. Co-author Guibo Xing, Ph.D., is a staff statistician at CHPR.