Reduction in dose in long-term prescription opioid users increases the risk of overdose and mental health crisis, according to a new study in JAMA. Guidelines from the Centers for Disease Control and Prevention, which included the recommendation for dose tapering under certain conditions, “have led to increased opioid tapering among patients prescribed long-term opioid therapy,” according to the study authors. The study is one of the largest and broadest looks at the risks of tapering.
To assess the risk, they collected deidentified information for over 113,000 patients on stable, long-term opioid therapy of at least 50 milligram morphine equivalents per day for at least 12 months. Tapering was defined as having at least a 15% reduction in dose for a minimum of 60 days. Outcome measures were occurrence of emergency or hospital encounters for drug overdose or mental health crisis (for depression, anxiety, or suicide attempt) in the 12 months following commencement of tapering.
Compared to patients whose doses were not tapered, patients whose doses were tapered had an adjusted rate ratio of 1.68 for overdose and 2.28 for mental health crisis.
“Among patients prescribed stable, long-term, higher-dose opioid therapy, tapering events were significantly associated with increased risk of overdose and mental health crisis,” the authors conclude. “The risks of long-term opioids are well-documented, particularly at higher doses and in the presence of other risk factors for opioid toxicity, and clinicians and patients must carefully weigh risks and benefits of both opioid continuation and tapering in decisions regarding ongoing opioid therapy.”
Agnoli A, Xing G, Tancredi DJ, et al. Association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids. JAMA. 2021;326(5):411-419. doi:10.1001/jama.2021.11013