Risks Associated With Prescription Opioid Dose Decrease or Discontinuation

Data suggest that discontinuation of prescription opioid medication after long-term high-dose opioid therapy may be associated with adverse outcomes, including overdose and suicide. Researchers used Oregon Medicaid data linked with prescription drug monitoring program and vital statistics data to characterize risks associated with opioid prescribing patterns after an episode of high-dose opioid prescribing (N=14,596).

  • Subsequent opioid prescribing patterns were: abrupt opioid medication discontinuation without >50% dose reduction (29% of episodes); opioid discontinuation after >50% dose reduction (11%); opioid continuation with >50% dose reduction (44%); and stable or increasing opioid dose (16%).
  • Compared with stable or increasing dose, the risk of suicide was higher with discontinuation, whether it was abrupt (adjusted hazard ratio [aHR], 3.63) or with dose reduction (aHR, 4.47).
  • Compared with stable or increasing dose, the risk of overdose was lower with abrupt discontinuation or dose reduction and discontinuation (aHR, 0.62 and 0.36, respectively).

Comments: This study provides observational data identifying adverse events associated with different patterns of opioid prescribing after receipt of long-term high-dose opioid therapy. For methodologic reasons, this study did not include patients receiving a truly stable opioid dose. These data highlight the need for risk assessment and mitigation for all patients receiving high-dose opioid medications for chronic pain.

Joseph Merrill, MD, MPH

Reference: Hallvik SE, El Ibrahimi S, Johnston K, et al. Patient outcomes following opioid dose reduction among patients with chronic opioid therapy. Pain. 2021;10.1097/j.pain.0000000000002298.

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