Opioid Tapering and Its Associations with Risk of Opioid Use Disorder and Mortality Among Older Adults
Author(s)
Yang Y1, Prajapati P2, Ramachandran S3, Bhattacharya K3, Maharjan S2, Eriator I4, Bazzazzadehgan S1, Bentley J3
1Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA, 2Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Oxford, MS, USA, 3Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Center for Pharmaceutical Marketing and Management, University of Mississippi School of Pharmacy, University, MS, USA, 4University of Mississippi Medical Center, Jackson, MS, USA
Presentation Documents
OBJECTIVES: Opioid tapering has increased in recent years, however, evidence regarding its safety profile is lacking. The purpose of this study was to examine the relationships between opioid tapering and subsequent opioid use disorder (OUD) and all-cause mortality among older adults on long-term opioid therapy (LTOT).
METHODS: This study used a nested case-control design. A cohort of older (≥65 years) Medicare beneficiaries with chronic non-cancer pain who were on LTOT was identified from 2012-2018 5% national Medicare claims data. Within this LTOT cohort, cases (beneficiaries who experienced either an OUD or mortality) and controls (identified using incidence density sampling) were identified and matched 1:2 on age (±1 year) and time of cohort entry (±30 days). Opioid tapering was operationalized as a monthly dose change percentage with four levels: steady dose (±10% dose change), tapering (10-40% dose reduction), rapid tapering (> 40% dose reduction), and dose escalation (>10% dose increase). Conditional logistic regression was conducted on the matched samples to evaluate the associations between opioid tapering and OUD and mortality.
RESULTS: A cohort of 42,091 patients met our inclusion criteria. Among them, 2,670 cases of OUD and 4,614 cases of mortality were identified. After controlling for patient socio-demographics and clinical characteristics, compared with steady dose, the odds of OUD were significantly lower (aOR=0.52; 95%CI=0.42-0.64) for rapid tapering and significantly higher (aOR=1.58; 95%CI=1.31-1.90) for dose escalation. Compared to steady dose, significantly higher odds for all-cause mortality were found among patients undergoing tapering (aOR=1.64, 95%CI=1.44-1.86), rapid tapering (aOR=2.33; 95%CI=2.10-2.59), and dose escalation (aOR=2.21, 95%CI=1.95-2.52).
CONCLUSIONS: The results suggest that opioid tapering was associated with increased risk of all-cause mortality but not OUD; opioid dose escalation was associated with both OUD and mortality. Clinicians should evaluate patients on LTOT to weigh the benefits and risks of treatment that incorporates evolving evidence surrounding dose changes.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
PT10
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
Drugs, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)