Amid the ongoing national opioid crisis, prescribing guidelines recommend against the use of higher doses of opioids for chronic pain management and for dose tapering to reduce morbidity and mortality. Research, however, has shown that there are harms associated with rapid dose reduction in people who have been prescribed long-term opioids. A retrospective cohort study used administrative claims data to determine the associations between dose tapering in patients prescribed stable, long-term, higher-dose opioid therapy and rates of overdose and mental health crisis.

Patients 18 years of age or older who were prescribed stable, high doses of opioids (a mean dose of at least 50 morphine milligram equivalents per day) for at least 12 months were eligible for the study. Tapering was defined as a mean daily dose that was at least 15% lower than the mean daily baseline dose.

The final cohort comprised 113,618 patients (after a total of 203,920 baseline periods). Posttapering patient periods were associated with an adjusted incidence rate of 9.3 overdose events per 100 person-years compared with 5.5 events per 100 person-years during nontapered periods (adjusted incidence rate ratio, 1.68). Tapering was associated with an adjusted incidence rate of 7.6 mental health crisis events per 100 person-years compared with 3.3 events per 100 person-years during nontapered periods (adjusted incidence rate ratio, 2.28). Increasing maximum monthly dose reduction velocity by 10% was associated with an increased adjusted incidence rate ratio for overdose (1.09) and mental health crisis (1.18).

According to the authors, their findings suggest adverse events associated with opioid dose tapering are common and support guidelines published in 2019 by the U.S. Department of Health and Human Services that recommend more gradual dose reductions when feasible and close monitoring during tapering.

They caution, however, that their findings are limited by the observational study design. Unmeasured variables could have contributed to the increased risk of adverse events, and tapering circumstances couldn't be assessed, the researchers note. In addition, illicit opioid use and methadone administration weren't measured.