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Opioid Tapering Linked With Increased Risk for Overdose, Mental Health Crises
Patients on stable but higher-dose opioid therapy for pain who had their doses tapered by at least 15% were found to have significantly higher rates of overdose and mental health crisis in their second year after tapering compared to their pre-tapering period, according to new research from the UC Davis Center for Healthcare Policy and Research.
Findings, published earlier this month in JAMA Network Open, were based on an examination of a database that included more than 28,000 patients who were prescribed long-term opioids between 2008 and 2017. Researchers looked at enrollment records and pharmacy claims for patients who were prescribed the equivalent of at least 50 morphine milligrams per day and had their doses reduced by at least 15%.
From this group, the researchers selected those who had at least 1 month of follow-up during the second year of their post-tapering period. A total of 21,515 tapering events—including emergency department visits or inpatient hospital admissions for overdose, withdrawal, or mental health crises—for 19,377 patients were identified.
Rates of such post-tapering events were then compared to the patients’ pre-tapering period. Researchers found that for every 100 patients, there was an average of 3.5 overdose or withdrawal events pre-tapering compared to 5.4 events and 4.4 crises in the 1 to 2 years post-tapering.
The findings suggest that clinicians and patients should discuss dose reduction and carefully weigh the pros and cons of tapering, and also that patients who are tapering from high-dose opioid prescriptions would benefit from monitoring and support to ensure they are safely adjusting to lower doses.
“We hope this work will inform a more cautious approach to decisions around opioid dose tapering,” study lead author Joshua Fenton, MD, MPH, professor and vice chair of research in the Department of Family and Community Medicine at UC Davis School of Medicine, said in a news release. “While our results suggest that all tapering patients may benefit from monitoring and support up to 2 years after taper initiation, patients prescribed higher doses may benefit from more intensive support and monitoring, particularly for depression and suicidality.”
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