TY - JOUR
T1 - Prescription Opioid Dose Reductions and Potential Adverse Events
T2 - a Multi-site Observational Cohort Study in Diverse US Health Systems
AU - Metz, Verena E.
AU - Ray, G. Thomas
AU - Palzes, Vanessa
AU - Binswanger, Ingrid
AU - Altschuler, Andrea
AU - Karmali, Ruchir N.
AU - Ahmedani, Brian K.
AU - Andrade, Susan E.
AU - Boscarino, Joseph A.
AU - Clark, Robin E.
AU - Haller, Irina V.
AU - Hechter, Rulin C.
AU - Roblin, Douglas W.
AU - Sanchez, Katherine
AU - Bailey, Steffani R.
AU - McCarty, Dennis
AU - Stephens, Kari A.
AU - Rosa, Carmen L.
AU - Rubinstein, Andrea L.
AU - Campbell, Cynthia I.
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Society of General Internal Medicine.
PY - 2023
Y1 - 2023
N2 - Background: In response to the opioid crisis in the United States, population-level prescribing of opioids has been decreasing; there are concerns, however, that dose reductions are related to potential adverse events. Objective: Examine associations between opioid dose reductions and risk of 1-month potential adverse events (emergency department (ED) visits, opioid overdose, benzodiazepine prescription fill, all-cause mortality). Design: This observational cohort study used electronic health record and claims data from eight United States health systems in a prescription opioid registry (Clinical Trials Network-0084). All opioid fills (excluding buprenorphine) between 1/1/2012 and 12/31/2018 were used to identify baseline periods with mean morphine milligram equivalents daily dose of ≥ 50 during six consecutive months. Patients: We identified 60,040 non-cancer patients with ≥ one 2-month dose reduction period (600,234 unique dose reduction periods). Main Measures: Analyses examined associations between dose reduction levels (1– < 15%, 15– < 30%, 30– < 100%, 100% over 2 months) and potential adverse events in the month following a dose reduction using logistic regression analysis, adjusting for patient characteristics. Key Results: Overall, dose reduction periods involved mean reductions of 18.7%. Compared to reductions of 1– < 15%, dose reductions of 30– < 100% were associated with higher odds of ED visits (OR 1.14, 95% CI 1.10, 1.17), opioid overdose (OR 1.41, 95% CI 1.09–1.81), and all-cause mortality (OR 1.39, 95% CI 1.16–1.67), but lower odds of a benzodiazepine fill (OR 0.83, 95% CI 0.81–0.85). Dose reductions of 15– < 30%, compared to 1– < 15%, were associated with higher odds of ED visits (OR 1.08, 95% CI 1.05–1.11) and lower odds of a benzodiazepine fill (OR 0.93, 95% CI 0.92–0.95), but were not associated with opioid overdose and all-cause mortality. Conclusions: Larger reductions for patients on opioid therapy may raise risk of potential adverse events in the month after reduction and should be carefully monitored.
AB - Background: In response to the opioid crisis in the United States, population-level prescribing of opioids has been decreasing; there are concerns, however, that dose reductions are related to potential adverse events. Objective: Examine associations between opioid dose reductions and risk of 1-month potential adverse events (emergency department (ED) visits, opioid overdose, benzodiazepine prescription fill, all-cause mortality). Design: This observational cohort study used electronic health record and claims data from eight United States health systems in a prescription opioid registry (Clinical Trials Network-0084). All opioid fills (excluding buprenorphine) between 1/1/2012 and 12/31/2018 were used to identify baseline periods with mean morphine milligram equivalents daily dose of ≥ 50 during six consecutive months. Patients: We identified 60,040 non-cancer patients with ≥ one 2-month dose reduction period (600,234 unique dose reduction periods). Main Measures: Analyses examined associations between dose reduction levels (1– < 15%, 15– < 30%, 30– < 100%, 100% over 2 months) and potential adverse events in the month following a dose reduction using logistic regression analysis, adjusting for patient characteristics. Key Results: Overall, dose reduction periods involved mean reductions of 18.7%. Compared to reductions of 1– < 15%, dose reductions of 30– < 100% were associated with higher odds of ED visits (OR 1.14, 95% CI 1.10, 1.17), opioid overdose (OR 1.41, 95% CI 1.09–1.81), and all-cause mortality (OR 1.39, 95% CI 1.16–1.67), but lower odds of a benzodiazepine fill (OR 0.83, 95% CI 0.81–0.85). Dose reductions of 15– < 30%, compared to 1– < 15%, were associated with higher odds of ED visits (OR 1.08, 95% CI 1.05–1.11) and lower odds of a benzodiazepine fill (OR 0.93, 95% CI 0.92–0.95), but were not associated with opioid overdose and all-cause mortality. Conclusions: Larger reductions for patients on opioid therapy may raise risk of potential adverse events in the month after reduction and should be carefully monitored.
KW - all-cause mortality
KW - benzodiazepine prescription fill
KW - emergency department visit
KW - opioid dose reduction
KW - opioid overdose
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U2 - 10.1007/s11606-023-08459-y
DO - 10.1007/s11606-023-08459-y
M3 - Article
AN - SCOPUS:85175852253
SN - 0884-8734
JO - Journal of general internal medicine
JF - Journal of general internal medicine
ER -