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. 2021 Mar;30(3):395-399.
doi: 10.1002/pds.5096. Epub 2020 Aug 26.

Identifying opioid dose reductions and discontinuation among patients with chronic opioid therapy

Sara E Hallvik  1 , Kirbee Johnston  2   3 , Jonah Geddes  2   3 , Gillian Leichtling  1 , P Todd Korthuis  4 , Daniel M Hartung  2   3
Affiliations

Identifying opioid dose reductions and discontinuation among patients with chronic opioid therapy

Sara E Hallvik et al. Pharmacoepidemiol Drug Saf. 2021 Mar.

Abstract

Purpose: To identify and systematically categorize opioid dose reductions and discontinuations in large administrative datasets.

Methods: Using a dataset of Oregon Medicaid beneficiaries linked with prescription drug monitoring program (PDMP) data between 2014 and 2017, we identified patients with high-dose chronic opioid therapy (COT), ≥84 consecutive days with an average daily MME of ≥50 on each of those days. We categorized patients into four mutually exclusive groups based on the trajectory of opioid use in the year after COT: abrupt discontinuation, dose reduction and discontinuation, dose reduction without discontinuation, and stable or increasing dose. Finally, we examined prescription patterns in each category.

Results: Among individuals with high-dose COT, 7636 (37.1%) had an abrupt discontinuation, 2577 (12.5%) had a dose reduction and discontinuation, 7739 (37.6%) had a dose reduction without discontinuation, and 2623 (12.8%) had a stable or increasing dose in the year following the COT episode. Among those who discontinued opioid use (n = 10 213, 49.6%), three in four (74.8%) did so without evidence of tapering. Patients who discontinued opioid use were younger, had higher daily MME during COT, and were more likely to have filled a benzodiazepine or had a multiple provider or multiple pharmacy episode compared to patients who did not discontinue opioid use.

Conclusions: Dose reductions and discontinuations after a COT episode can be identified in large administrative datasets. Those with a discontinuation were more likely to have riskier prescription profiles during their COT episode.

Keywords: discontinuation; dose reduction; opioids; pharmacoepidemiology.

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Figures

FIGURE 1
FIGURE 1
Timeline for inclusion of the COT cohort
See this image and copyright information in PMC

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