Tapering Long-Term Opioid Treatment May Have Unintended Health Effects

Tapering long-term opioid therapy (LTOT) is associated with more visits to the emergency department (ED) and poorer adherence to antihypertensive or antidiabetic medications, according to results of a study published in JAMA Network Open.

Researchers from University of California, Davis sourced data for this study from the Optum Labs Data Warehouse (OLDW). They included adult patients (N=113,604; mean age, 58.1 [11.8] years; 53% women) who were prescribed a stable LTOT dose of 50 morphine milligram equivalents (MME) or greater for 12 months or longer between 2007 and 2019 in this analysis. The primary outcomes were visits to the ED, hospitalizations, and outpatient visits. The researchers also evaluated among subsets of patients with hypertension (n=41,207) or diabetes (n=23,335), adherence to antihypertensive and antidiabetic medications and blood pressure and glycated hemoglobin (HbA1C) levels. The study compared patients who tapered their opioid dose by 15% or more in a 6 month span, and those who tapered long-term opioid dosing.

The cohort had a mean opioid dose of between 50 and 90 MME, 28.1% had a benzodiazepine coprescription, and 0.8% had a history of drug overdose.

Among the whole cohort and the subsets with hypertension and diabetes, 24% to 26% tapered their long-term opioids.

Tapering opioids is associated with increased rates of all-cause ED visits (adjusted incidence rate ratio [aIRR], 1.19; 95% CI, 1.16-1.21) and ED visits for ambulatory care-sensitive conditions (ACSC; aIRR, 1.13; 95% CI, 1.05-1.21) as well as all-cause hospitalizations (aIRR, 1.16; 95% CI, 1.12-1.20) and hospitalizations of ACSC reasons (aIRR, 1.14; 95% CI, 1.08-1.21) compared with no tapering. Conversely, the patients who tapered their LTOT had fewer visits with their primary care doctor than those who did not taper (aIRR, 0.95; 95% CI, 0.94-0.96).

Among patients with hypertension, the researchers report that tapering long-term opioids reduces antihypertensive medication adherence, compared with no tapering (aIRR, 0.60; 95% CI, 0.59-0.62).

Similar trends were observed among the diabetes cohort with regard to antidiabetic medication adherence (aIRR, 0.69; 95% CI, 0.67-0.71).

The research shows that tapering long-term opioid therapy is associated with a modest, but significant, decline in diastolic blood pressure (β, 0.6 mm Hg) and HbA1C (β, 0.06%) management among patients with hypertension or diabetes, respectively.

This study may have been limited by not having access to information about motivations for long-term opioid therapy tapering.

The report shows patients tapering long-term opioids had increased ED visits and those with chronic conditions had decreased medication adherence.

“Although cautious interpretation is warranted, these outcomes may represent unintended negative consequences of opioid tapering in patients who were prescribed previously stable doses,” the study authors report.

This article originally appeared on Clinical Pain Advisor