OBJECTIVES: Opioid tapering and discontinuation have increased in recent years with the implementation of national prescribing guidelines. This study examined the relationship between opioid tapering velocity and mental health crisis (MHC) events among Medicare-enrolled older adults with chronic non-cancer pain (CNCP) on long-term opioid therapy (LTOT).

METHODS: A nested case-control study was conducted using 2012-2018 5% national Medicare administrative claims data sample. Eligible beneficiaries were on LTOT, continuously enrolled, had no claims with a cancer diagnosis or hospice use, and ≥2 claims with diagnoses for CNCP conditions within a 30-day period during 6 months prior to cohort entry date. Cases were defined as individuals experiencing MHC events (depression, anxiety, or suicidal ideation); controls were identified using incidence density sampling. The opioid tapering velocity was measured in 120-day hazard period that yielded a monthly percentage of dose change. Conditional logistic regression was used to assess the relationship.

RESULTS: A total of 42,091 older adults with CNCP were eligible for the study. Cases (n=1,136) were matched with controls in a 1:2 ratio based on age (±1 year) and time of cohort entry (±30 days). A higher percentage of controls (68.93%) were on steady dose compared with cases (60.04%). After adjusting for potential covariates, individuals undergoing tapering (aOR=1.47; 95% CI: 1.13 – 1.90) and rapid tapering (aOR=1.32; 95% CI: 1.04 – 1.67) were found to have greater odds of experiencing MHC events relative to those on a steady dose. In addition, opioid dose escalation (aOR=1.96; 95% CI: 1.53 – 2.53) was also found to be significantly associated with the occurrence of MHC events, compared with a steady dose.

CONCLUSIONS: Both opioid tapering and dose escalation were associated with MHC events. Patient-driven and gradual dose tapering, as recommended by prescribing guidelines, should be promoted to prevent MHC events among older adults on LTOT.