Long-term opioid therapy (LTOT) for chronic pain is associated with a dose-dependent increased risk of opioid-related harms. Numerous policy and practice initiatives have promoted LTOT tapering despite a lack of evidence to guide tapering practices. Recently, emerging reports of harms associated with involuntary and/or rapid LTOT tapers led authors of the 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain, the Food and Drug Administration (FDA), and the US Department of Health and Human Services to publish cautionary guidance on LTOT tapering practices. While the population-level prescription opioid supply has fallen in the US in recent years, LTOT tapering trends are unknown. This study examined trends in the rate and rapidity of tapering among more than 100,000 individuals receiving stable LTOT in a large US claims database from 2008 through 2017.
- The percentage of LTOT recipients experiencing tapers increased gradually from 11% in 2008 to 14% in 2015, and then more sharply to 16% in 2016 and 22% in 2017.
- 19% of LTOT tapers were classified as rapid with a rate exceeding 40% dosage reduction per month (10% per week).
- Rapid LTOT tapering was more common in 2016–2017 compared with earlier years.
Comments: The rate and rapidity of LTOT tapering increased substantially in 2016 and 2017, corresponding with contemporaneous initiatives targeting LTOT, including the publishing of the CDC guideline. Nearly 1 in 5 tapers proceeded at a rate exceeding expert opinion maximum rates of 10% per week. In the absence of evidence-based LTOT tapering protocols, policies and practices should be instituted to support and incentivize providers to avoid involuntary, rapid LTOT tapers.
Marc R. Larochelle, MD, MPH
Reference: Fenton JJ, Agnoli AL, Xing G, et al. Trends and rapidity of dose tapering among patients prescribed long-term opioid therapy, 2008–2017. JAMA Netw Open. 2019;2(11):e1916271.