Increased Risk for Developing Alcohol Use Disorder in Individuals Tapering Long-term Opioid Medications

Alcohol use during receipt of long-term opioid therapy (LTOT) increases risks for harm. Individuals with unhealthy alcohol use or alcohol use disorder (AUD) also have increased risk for developing prescription opioid use disorder (OUD). This retrospective cohort study assessed incidence of developing an alcohol-related condition during LTOT receipt and the association between LTOT and alcohol-related conditions on mortality risk.

• The cohort consisted of 3912 patients prescribed LTOT across three health systems.
• Alcohol-related conditions were diagnosed in 8 percent of individuals. OUD was diagnosed in 7 percent of individuals.
• The incidence of alcohol-related conditions was highest for individuals who were tapering LTOT, compared with those receiving stable LTOT (adjusted hazard ratio, 2.23).
• Alcohol-related conditions, regardless of LTOT trajectory, were not significantly associated with mortality risk.

Comments: This study highlights the increased risk for developing alcohol-related conditions such as AUD during LTOT receipt, especially while tapering LTOT. The study had important limitations, including unclear screening and identification of unhealthy alcohol use and AUD, but it adds important evidence to support screening and monitoring for alcohol use during administration of LTOT. LTOT risk-mitigation strategies that only focus on opioid-related harms will miss the potential harms related to alcohol use.

Melissa B. Weimer, DO, MCR

Reference: Pytell JD, Narwaney KJ, Nguyen AP, et al. New alcohol-related condition diagnoses are associated with opioid tapers among patients receiving long-term opioid therapy. J Addict Med. 2025;19(3):290–297.