The article, “Association Between Opioid Dose Reduction Rates and Overdose Among Patients Prescribed Long-Term Opioid Therapy,” has been published in SAj.
In this commentary, the authors state that tapering long-term opioid therapy is an increasingly common practice, yet rapid opioid dose reductions may increase the risk of overdose. The objective of their study was to compare overdose risk following opioid dose reduction rates of ≤10%, 11% to 20%, 21% to 30%, and >30% per month to stable dosing.
In the AUTHORS’ OWN WORDS, they relate the importance of their work:
“In response to the opioid crisis, the Centers for Disease Control and Prevention (CDC) and other organizations issued guidelines to encourage safer opioid prescribing practices. The CDC Guidelines recommend that clinicians closely monitor patients prescribed opioids to re-evaluate whether the benefits of opioid therapy outweigh the harms, which may include opioid use disorder and overdose. When harms exceed benefits, guidelines encourage clinicians to consider slowly tapering the patient’s opioid dose, beginning with a 10% dose reduction per month for patients taking opioids for years, and 10% per week for shorter opioid therapy durations. These tapering rate recommendations, however, were based on limited evidence, and it has been suggested that inappropriately rapid tapers increase the risk for heroin use, suicide, and, paradoxically, overdose.”
“Using electronic health record (EHR) data from three diverse health systems, we identified patients prescribed LTOT and applied a scan statistic methodology to identify opioid dose patterns across the follow-up, including stable doses and dose reduction rates of ≤10%, 11 to 20%, 21 to 30%, and >30% per month. We conducted a retrospective cohort study to examine the effect of the different dose reduction rates on the incidence of overdoses occurring at 1, 3, 6, 9, and 12 months after initiation of a dose reduction. We hypothesized that faster dose reductions would be associated with higher overdose risks.”