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

  • Hector R. PerezEmail author
  • Michele Buonora
  • Chinazo O. Cunningham
  • Moonseong Heo
  • Joanna L. Starrels
Original Research

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.

KEY WORDS

chronic pain primary care patient safety care management 

Notes

Funding Information

Financial support for this project was provided by the following grants: K23DA044327 (PI: Perez), R01DA039046 and K24DA046309 (PI: Starrels), and K24DA036955 (PI: Cunningham).

Compliance with Ethical Standards

The study was approved by the Albert Einstein College of Medicine and Montefiore Medical Center Institutional Review Board.

Conflict of Interest

Dr. Starrels discloses receiving research support from the Opioid Post-Marketing Requirement Consortium, an FDA-mandated consortium of opioid manufacturers, for an observational study of the risks of opioids. Dr. Cunningham discloses holding stock and stock options in Quest Diagnostics. All remaining authors declare that they do not have conflict of interests.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Hector R. Perez
    • 1
    Email author
  • Michele Buonora
    • 1
  • Chinazo O. Cunningham
    • 1
  • Moonseong Heo
    • 2
  • Joanna L. Starrels
    • 1
  1. 1.Montefiore Medical Center Albert Einstein College of MedicineBronxUSA
  2. 2.Department of Public Health Sciences, College of Behavioral, Social and Health SciencesClemson UniversityClemsonUSA

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