Perez Hector R, Buonora Michele, Cunningham Chinazo O, Heo Moonseong, Starrels Joanna L
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, USA.
J Gen Intern Med. 2020 Jan;35(1):36-42. doi: 10.1007/s11606-019-05227-9. Epub 2019 Aug 19.
Opioid tapering is increasingly utilized by providers to decrease risks of chronic opioid therapy, but it is unknown whether tapering is associated with termination of care.
To determine whether patients taking chronic opioid therapy who experienced opioid tapers were at greater risk of subsequently terminating their care compared with those who were continued on their doses.
Retrospective cohort study of patients in a large, urban health system between 2008 and 2012 with 2 years of follow-up.
Adult patients prescribed a stable baseline dose of chronic opioid therapy of at least 25 morphine milligram equivalents per day during a baseline year.
An opioid taper during an exposure year, defined as a reduction in the average daily dose of at least 30% from the baseline dose in both of the two 6-month periods in the year following the baseline year. Opioid dose continuation was defined as any increase in dose, no change in dose, or any decrease up to 30% compared with baseline dose in the exposure year. The primary outcome was termination of care, defined as no outpatient encounters in the health system, in the year following the exposure year.
Of 1624 patients on chronic opioid therapy, 207 (15.5%) experienced an opioid taper and 78 (4.8%) experienced termination of care. Compared with opioid dose continuation, opioid taper was significantly associated with termination of care (AOR 4.3 [95% CI 2.2-8.5]).
Opioid taper is associated with subsequent termination of care. These findings invite caution and demonstrate the need to fully understand the risks and benefits of opioid tapers.
医疗服务提供者越来越多地采用阿片类药物减量疗法来降低长期使用阿片类药物治疗的风险，但尚不清楚药物减量是否与终止治疗有关。
确定与继续维持原剂量的患者相比，接受阿片类药物减量治疗的慢性阿片类药物治疗患者随后终止治疗的风险是否更高。
对2008年至2012年期间一家大型城市医疗系统中的患者进行回顾性队列研究，并进行为期2年的随访。
成年患者在基线年份每天接受至少25毫克吗啡当量的稳定基线剂量慢性阿片类药物治疗。
暴露年份的阿片类药物减量，定义为在基线年份后的一年中，两个6个月期间的平均每日剂量均比基线剂量减少至少30%。阿片类药物剂量维持定义为与暴露年份的基线剂量相比，剂量增加、不变或减少至多30%。主要结局是终止治疗，定义为在暴露年份后的一年中，在该医疗系统中没有门诊就诊。
在1624例接受慢性阿片类药物治疗的患者中，207例（15.5%）经历了阿片类药物减量，78例（4.8%）经历了终止治疗。与维持阿片类药物剂量相比，阿片类药物减量与终止治疗显著相关（调整后比值比4.3 [95%置信区间2.2 - 8.5]）。
阿片类药物减量与随后的终止治疗有关。这些发现提示需谨慎行事，并表明有必要充分了解阿片类药物减量的风险和益处。
