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Longitudinal Dose Trajectory Among Patients Tapering Long-Term Opioids.

  • Fenton, Joshua J1, 2
  • Magnan, Elizabeth M1, 2
  • Agnoli, Alicia L1, 2
  • Henry, Stephen G2, 3
  • Xing, Guibo2
  • Tancredi, Daniel J2, 4
  • 1 Departments of Family and Community Medicine, Davis, Sacramento, California, USA.
  • 2 the Center for Healthcare Policy and Research, Davis, Sacramento, California, USA.
  • 3 Internal Medicine, Davis, Sacramento, California, USA.
  • 4 Pediatrics, University of California, Davis, Sacramento, California, USA.
Published Article
Pain medicine (Malden, Mass.)
Publication Date
Jul 25, 2021
DOI: 10.1093/pm/pnaa470
PMID: 33738505


To evaluate the dose trajectory of new opioid tapers and estimate the percentage of patients with sustained tapers at long-term follow-up. Retrospective cohort study. Data from the OptumLabs Data Warehouse® which includes de-identified medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees, representing a diverse mixture of ages, ethnicities, and geographical regions across the United States. Patients prescribed stable, higher-dose opioids for ≥12 months from 2008 to 2018. Tapering was defined as ≥15% relative reduction in average MME/day during any of six overlapping 60-day periods in the initial 7 months of follow-up after the period of stable baseline dosing. Average monthly dose was ascertained during consecutive 60-day periods up to 16 months of follow-up. Linear regression estimated the geometric mean relative dose by tapering status and follow-up duration. Poisson regression estimated the percentage of tapered patients with sustained dose reductions at follow-up and patient-level predictors of failing to sustain tapers. The sample included 113,618 patients with 203,920 periods of stable baseline dosing (mean follow-up = 13.7 months). Tapering was initiated during 37,170 follow-up periods (18.2%). After taper initiation, patients had a substantial initial mean dose reduction (geometric mean relative dose .73 [95% CI: .72-.74]) that was sustained through 16 months of follow-up; at which point, 69.8% (95% CI: 69.1%-70.4%) of patients who initiated tapers had a relative dose reduction ≥15%, and 14.2% (95% CI: 13.7%-14.7%) had discontinued opioids. Failure to sustain tapers was significantly less likely among patients with overdose events during follow-up (adjusted incidence rate ratio [aIRR]: .56 [95% CI: .48-.67]) and during more recent years (aIRR: .93 per year after 2008 [95% CI: .92-.94]). In an insured and Medicare Advantage population, over two-thirds of patients who initiated opioid dose tapering sustained long-term dose reductions, and the likelihood of sustaining tapers increased substantially from 2008 to 2018. © The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected]

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