Doctor with pill bottle, spilling medication into hand

Clinicians may wish to carefully weigh the risks and benefits when considering drug tapering for patients on long-term opioids therapy with stable doses, the results of a new study suggest. This action may trigger a series of unintended consequences, investigators say.

The researchers used commercial and Medicare Advantage data to conduct a retrospective cohort study of 113,000 adult patients from 2008 to 2019. During a 12-month baseline period, patients were prescribed long-term opioid therapy at 50 morphine milligram equivalents per day.

Patients received opioid tapering interventions at some point after those 12 months. This included a 15% or greater reduction in their average daily doses. 

Opioid tapering was linked to fewer primary care visits, an increase in visits to the emergency department and an uptick in hospitalizations, investigators found. In patients with hypertension or diabetes, opioid tapering was associated with decreased medication adherence — the equivalent of up to 10 days per month without taking prescribed medications for these diseases, Joshua J. Fenton, MD, of University of California, Davis, reported. 

Doctor visits decrease

These outcomes may be due to fractured doctor-patient relationships or a lack of perceived need for care after opioid tapering, Fenton and colleagues wrote. Fewer doctor visits may mean less attention to care, including medication followup, which in turn can lead to worsened clinical status and more high acuity health events.

This hypothesis is supported by prior research findings, the authors added. The Centers for Disease Control and Prevention in 2016 set a goal to reduce overdose risks associated with higher-dose opioid use, and opioid tapering has increased since then, the researchers reported. But tapering in patients on long-term treatment has been associated with clinical disruptions, worsened pain control and other poor outcomes, including termination of outpatient care.

Although a “cautious interpretation” of the new study results is warranted, clinicians should take note, the researchers said. “[T]hese outcomes may represent unintended negative consequences of opioid tapering in patients who were prescribed previously stable doses,” they concluded.

The study was published in JAMA Network Open.

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