Study finds opioid tapering may have unintended negative healthcare consequences

Efforts to taper long-term opioid therapy have increased in recent years, to reduce overdose risks associated with higher-dose opioid use. However, a better understanding is needed of the potential negative outcomes associated with tapering of long-term opioid therapy, including the use of healthcare services, particularly among patients with comorbid chronic conditions requiring regular ambulatory care. To evaluate tapering of stable long-term opioid therapy and its effects on subsequent healthcare service use and chronic condition care, a retrospective cohort study was conducted. U.S. administrative claims data (over an 11-year period) were analyzed for adults prescribed stable doses of long-term opioid therapy (≥ 50 mg morphine equivalents/day) who underwent opioid tapering (with ≥ 15% or more relative reduction in mean daily dose during six overlapping 60-day periods after a 12-month baseline period of stable dosing). To examine tapering among patients with chronic conditions, hypertension and diabetes subcohorts were identified. Results showed the following: A total of 113,604 patients (53.5% women; mean age, 58.1 years) were prescribed long-term opioid therapy; 41,207 had hypertension and 23,335 had diabetes. In the overall cohort, tapering was associated with more emergency department visits (adjusted incidence rate ratio [aIRR], 1.19; 95%CI, 1.16–1.21) and hospitalizations (aIRR, 1.16; 95%CI, 1.12–1.20). Associations of similar magnitude were seen in the hypertension and diabetes subcohorts. Tapering was associated with fewer primary care visits in the overall cohort (aIRR, 0.95; 95%CI, 0.94–0.96) and in the hypertension subcohort (aIRR, 0.98; 95%CI, 0.97–0.99). In the hypertension or diabetes subcohorts, tapering was associated with reduced medication adherence (hypertension: aIRR, 0.60; 95%CI, 0.59–0.62; diabetes: aIRR, 0.69; 95%CI, 0.67–0.71), along with small but statistically significant increases in diastolic blood pressure and hemoglobin A1c (A1C) level. Among patients with hypertension or diabetes, opioid tapering was associated with significant reductions in adjusted mean number of days covered with any antihypertensive or antiglycemic medication over a year, equivalent to nine to 10 days per month without any medication, in the tapered compared with the nontapered state. The authors conclude that in this cohort study of patients prescribed long-term opioid therapy, opioid tapering was associated with more emergency department visits and hospitalizations, fewer primary care visits, and reduced antihypertensive and antidiabetic medication adherence. The authors believe that policy makers and clinicians need to consider these potential unintended negative consequences of opioid tapering. Reference 1. Magnan EM, Tancredi DJ, Xing G, et al. Association between opioid tapering and subsequent health care use, medication adherence, and chronic condition control. JAMA Network Open 2023;6(2):e2255101. (accessed February 9, 2023).

Study finds opioid tapering may have unintended negative healthcare consequences

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