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

Sara E. Hallvik, Kirbee Johnston, Jonah Geddes, Gillian Leichtling, P. Todd Korthuis, Daniel M. Hartung

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)395-399
Number of pages5
JournalPharmacoepidemiology and Drug Safety
Volume30
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • discontinuation
  • dose reduction
  • opioids
  • pharmacoepidemiology

ASJC Scopus subject areas

  • Epidemiology
  • Pharmacology (medical)

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