Longitudinal Dose Trajectory Among Patients Tapering Long-Term Opioids

Area of Science:

• Pharmacology
• Public Health
• Clinical Pharmacy

Background:

• Opioid tapering is a critical strategy for managing long-term opioid therapy.
• Understanding dose trajectory and sustained reduction is essential for patient outcomes.
• Previous studies have varied in their assessment of long-term opioid dose reduction success.

Purpose of the Study:

• To evaluate the dose trajectory of new opioid tapers.
• To estimate the percentage of patients achieving sustained opioid tapers at long-term follow-up.

Main Methods:

• Retrospective cohort study using de-identified medical and pharmacy claims data.
• Included patients with stable, higher-dose opioid prescriptions for ≥12 months (2008-2018).
• Defined tapering as ≥15% relative reduction in average Morphine Milligram Equivalent (MME)/day over 60-day periods; analyzed dose up to 16 months.

Main Results:

• 18.2% of stable high-dose opioid periods involved tapering initiation in 113,618 patients.
• Mean initial dose reduction was substantial (0.73 MME/day), sustained through 16 months.
• 69.8% of patients sustained ≥15% dose reduction; 14.2% discontinued opioids. Overdose events and recent years predicted sustained tapers.

Conclusions:

• Over two-thirds of patients initiating opioid dose tapering sustained long-term dose reductions.
• The likelihood of sustaining opioid tapers increased significantly from 2008 to 2018.
• Findings highlight the effectiveness of opioid dose reduction strategies in a large, diverse population.