A new study finds that tapering, or gradually reducing, opioid use may have unintended negative health impacts for some patients on long-term opioid therapy.
UC Davis Health researchers examined data from more than 110,000 patients who had been receiving stable long-term opioid therapy. They found that opioid tapering was associated with fewer primary care visits and a significant increase in emergency department visits and hospitalizations.
There were additional risks for patients with diabetes or high blood pressure. The researchers found a considerable decrease in their adherence to the medications they needed to control their chronic conditions.
"There is emerging evidence, from this current study and others, of previously unrecognized potential harms of tapering long-term stable opioids," said Elizabeth Magnan, associate professor of family and community medicine and first author on the study.
A previous study by UC Davis Health showed associations between opioid tapering and mental health crises and overdose.
"Patients and clinicians should be aware of both the potential risks and benefits of opioid tapers and should be thoughtful about when and how to taper opioid medications," Magnan said.
There is emerging evidence, from this current study and others, of previously unrecognized potential harms of tapering long-term stable opioids. Patients and clinicians should be aware of both the potential risks and benefits of opioid tapers and should be thoughtful about when and how to taper opioid medications."-Elizabeth Magnan
Push for opioid use reduction
Between 1999 and 2013, opioid-related drug overdose deaths made up approximately 77% of all drug overdose deaths. This continued to increase to 81% in 2014. In response to sharp increases in overdose deaths related to opioids, the Centers for Disease Control and Prevention changed the guidelines for prescribing opioid therapy in 2016.
Since the change in guidelines, tapering has become a standard practice for patients on higher doses of opioids, due to concerns about overdose and addiction.
According to Magnan, patients and physicians have begun to take note of negative consequences associated with tapering. As a result, clinicians are starting to be more careful with tapering and taper less frequently.
Further, as observations continue pointing to adverse effects of tapering, the CDC again updated its guidelines in 2022, emphasizing:
- Individualized patient care
- Safe and effective pain management options
- Improving communication between clinicians and patients so they can make decisions together about the best care for the patient
- Reducing risks associated with opioid pain therapy, including opioid use disorder, overdose and death
Study findings and considerations
To evaluate tapering, the researchers looked at administrative claims data. They used the Optum Labs Data Warehouse database, which has long-term health information on patients of various ages across the U.S. The researchers included 113,604 patients aged 18 years or older who had been on stable doses of long-term opioid therapy for 12 months or longer. The data was gathered between Jan. 1, 2008, and Dec. 31, 2019. It included general population patients and patients who also had hypertension or diabetes.
The study focused on patients who were tapering by 15% or more over a 60-day period.
The researchers found an increase in emergency department visits and hospitalizations in both the general patient population and those with hypertension and diabetes. However, there was a decrease in primary care visits. The authors could not determine the reasons for this decrease with the available data. They suggest further research is needed in this area.
Lastly, patients with high blood pressure (hypertension) and diabetes showed reduced adherence to medications for their chronic conditions. They also had small increases in blood pressure and hemoglobin A1c levels, which are linked to complications of these conditions.
It is always important for patients and physicians to have informed, shared decision-making conversations on dose reduction or maintenance. While tapering can be the best option for some patients, findings from this study give us pause."-Joshua Fenton, professor and vice chair of research, Department of Family and Community Medicine
What's next for opioid tapering guidance?
The study warned of the potential unintended negative consequences associated with tapering, particularly for patients with chronic conditions that require constant care. It called for more studies that can help inform policymakers and clinicians on how to approach opioid use guidelines while keeping the focus on patient-centered care.
"It is always important for patients and physicians to have informed, shared decision-making conversations on dose reduction or maintenance," said Joshua Fenton, professor and vice chair of research in the Department of Family and Community Medicine and senior author on the study. "While tapering can be the best option for some patients, findings from this study give us pause."
