Opioid Taper Is Associated with Subsequent Termination of Care: a Retrospective Cohort Study

Hector R. Perez, Michele Buonora, Chinazo O. Cunningham, Moonseong Heo, Joanna L. Starrels

Research output: Contribution to journalArticle

Abstract

Background: Opioid tapering is increasingly utilized by providers to decrease risks of chronic opioid therapy, but it is unknown whether tapering is associated with termination of care. Objective: To determine whether patients taking chronic opioid therapy who experienced opioid tapers were at greater risk of subsequently terminating their care compared with those who were continued on their doses. Design: Retrospective cohort study of patients in a large, urban health system between 2008 and 2012 with 2 years of follow-up. Participants: Adult patients prescribed a stable baseline dose of chronic opioid therapy of at least 25 morphine milligram equivalents per day during a baseline year. Main Measures: An opioid taper during an exposure year, defined as a reduction in the average daily dose of at least 30% from the baseline dose in both of the two 6-month periods in the year following the baseline year. Opioid dose continuation was defined as any increase in dose, no change in dose, or any decrease up to 30% compared with baseline dose in the exposure year. The primary outcome was termination of care, defined as no outpatient encounters in the health system, in the year following the exposure year. Key Results: Of 1624 patients on chronic opioid therapy, 207 (15.5%) experienced an opioid taper and 78 (4.8%) experienced termination of care. Compared with opioid dose continuation, opioid taper was significantly associated with termination of care (AOR 4.3 [95% CI 2.2–8.5]). Conclusions: Opioid taper is associated with subsequent termination of care. These findings invite caution and demonstrate the need to fully understand the risks and benefits of opioid tapers.

Original languageEnglish (US)
JournalJournal of General Internal Medicine
DOIs
StateAccepted/In press - Jan 1 2019

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Opioid Analgesics
Cohort Studies
Retrospective Studies
Urban Health
Therapeutics
Morphine
Outpatients

Keywords

  • care management
  • chronic pain
  • patient safety
  • primary care

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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title = "Opioid Taper Is Associated with Subsequent Termination of Care: a Retrospective Cohort Study",
abstract = "Background: Opioid tapering is increasingly utilized by providers to decrease risks of chronic opioid therapy, but it is unknown whether tapering is associated with termination of care. Objective: To determine whether patients taking chronic opioid therapy who experienced opioid tapers were at greater risk of subsequently terminating their care compared with those who were continued on their doses. Design: Retrospective cohort study of patients in a large, urban health system between 2008 and 2012 with 2 years of follow-up. Participants: Adult patients prescribed a stable baseline dose of chronic opioid therapy of at least 25 morphine milligram equivalents per day during a baseline year. Main Measures: An opioid taper during an exposure year, defined as a reduction in the average daily dose of at least 30{\%} from the baseline dose in both of the two 6-month periods in the year following the baseline year. Opioid dose continuation was defined as any increase in dose, no change in dose, or any decrease up to 30{\%} compared with baseline dose in the exposure year. The primary outcome was termination of care, defined as no outpatient encounters in the health system, in the year following the exposure year. Key Results: Of 1624 patients on chronic opioid therapy, 207 (15.5{\%}) experienced an opioid taper and 78 (4.8{\%}) experienced termination of care. Compared with opioid dose continuation, opioid taper was significantly associated with termination of care (AOR 4.3 [95{\%} CI 2.2–8.5]). Conclusions: Opioid taper is associated with subsequent termination of care. These findings invite caution and demonstrate the need to fully understand the risks and benefits of opioid tapers.",
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author = "Perez, {Hector R.} and Michele Buonora and Cunningham, {Chinazo O.} and Moonseong Heo and Starrels, {Joanna L.}",
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AU - Buonora, Michele

AU - Cunningham, Chinazo O.

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AU - Starrels, Joanna L.

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N2 - Background: Opioid tapering is increasingly utilized by providers to decrease risks of chronic opioid therapy, but it is unknown whether tapering is associated with termination of care. Objective: To determine whether patients taking chronic opioid therapy who experienced opioid tapers were at greater risk of subsequently terminating their care compared with those who were continued on their doses. Design: Retrospective cohort study of patients in a large, urban health system between 2008 and 2012 with 2 years of follow-up. Participants: Adult patients prescribed a stable baseline dose of chronic opioid therapy of at least 25 morphine milligram equivalents per day during a baseline year. Main Measures: An opioid taper during an exposure year, defined as a reduction in the average daily dose of at least 30% from the baseline dose in both of the two 6-month periods in the year following the baseline year. Opioid dose continuation was defined as any increase in dose, no change in dose, or any decrease up to 30% compared with baseline dose in the exposure year. The primary outcome was termination of care, defined as no outpatient encounters in the health system, in the year following the exposure year. Key Results: Of 1624 patients on chronic opioid therapy, 207 (15.5%) experienced an opioid taper and 78 (4.8%) experienced termination of care. Compared with opioid dose continuation, opioid taper was significantly associated with termination of care (AOR 4.3 [95% CI 2.2–8.5]). Conclusions: Opioid taper is associated with subsequent termination of care. These findings invite caution and demonstrate the need to fully understand the risks and benefits of opioid tapers.

AB - Background: Opioid tapering is increasingly utilized by providers to decrease risks of chronic opioid therapy, but it is unknown whether tapering is associated with termination of care. Objective: To determine whether patients taking chronic opioid therapy who experienced opioid tapers were at greater risk of subsequently terminating their care compared with those who were continued on their doses. Design: Retrospective cohort study of patients in a large, urban health system between 2008 and 2012 with 2 years of follow-up. Participants: Adult patients prescribed a stable baseline dose of chronic opioid therapy of at least 25 morphine milligram equivalents per day during a baseline year. Main Measures: An opioid taper during an exposure year, defined as a reduction in the average daily dose of at least 30% from the baseline dose in both of the two 6-month periods in the year following the baseline year. Opioid dose continuation was defined as any increase in dose, no change in dose, or any decrease up to 30% compared with baseline dose in the exposure year. The primary outcome was termination of care, defined as no outpatient encounters in the health system, in the year following the exposure year. Key Results: Of 1624 patients on chronic opioid therapy, 207 (15.5%) experienced an opioid taper and 78 (4.8%) experienced termination of care. Compared with opioid dose continuation, opioid taper was significantly associated with termination of care (AOR 4.3 [95% CI 2.2–8.5]). Conclusions: Opioid taper is associated with subsequent termination of care. These findings invite caution and demonstrate the need to fully understand the risks and benefits of opioid tapers.

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