Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, USA.
Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, USA.
Drug Alcohol Depend. 2022 May 1;234:109392. doi: 10.1016/j.drugalcdep.2022.109392. Epub 2022 Mar 3.
While reduced exposure to prescription opioids may decrease risks, including overdose and opioid use disorder, abrupt tapering or discontinuation may pose new risks.
To examine potentially unsafe tapering and discontinuation among dosage changes in opioid prescriptions dispensed to US patients on high-dose long-term opioid therapy.
Longitudinal observational study of adults (≥18 years) on stable high-dose (≥50 oral morphine milligram equivalents [MME] daily dosage) long-term opioid therapy during a 180-day baseline and a 360-day follow-up using all-payer pharmaceutical claims data, 2017-2019.
Dosage tapering, increases, and/or stability during follow-up; sustained dosage stability, reductions, or discontinuation at the end of follow-up; and tapering rate. Patients could experience more than one outcome during follow-up.
Among 595,078 patients receiving high-dose long-term opioid therapy in the sample, 26.7% experienced sustained dosage reductions and 9.3% experienced discontinuation. Among patients experiencing tapering, 62.0% experienced maximum taper rates between > 10-40% reductions per month and 36.1% experienced monthly rates ≥ 40%. Among patients with mean baseline daily dosages ≥ 150 MME, 47.7% experienced a maximum taper rate ≥ 40% per month. Relative to baseline, 19.7% of patients experiencing tapering had long-term dosage reductions ≥ 40% per month at the end of follow-up.
Dosage changes for patients on high-dose long-term opioid therapy may warrant special attention, particularly over shorter intervals, to understand how potentially sudden tapering and discontinuation can be reduced while emphasizing patient safety and shared decision-making. Rapid discontinuation of opioids can increase risk of adverse outcomes including opioid withdrawal.
减少处方类阿片的使用量可能会降低风险，包括用药过量和阿片类药物使用障碍，但突然减少或停药可能会带来新的风险。
研究接受高剂量长期阿片类药物治疗的美国患者在处方剂量改变时，是否存在潜在不安全的减量和停药情况。
利用 2017-2019 年全支付者药物索赔数据，对 180 天基线期和 360 天随访期内接受稳定高剂量（≥50 口服美沙酮毫克当量[MME]日剂量）长期阿片类药物治疗的成年人（≥18 岁）进行纵向观察性研究。
随访期间的剂量减少、增加和/或稳定；随访结束时持续剂量稳定、减少或停药；以及减量率。患者在随访期间可能会经历多种结局。
在样本中接受高剂量长期阿片类药物治疗的 595078 名患者中，26.7%的患者持续减少剂量，9.3%的患者停药。在经历减量的患者中，62.0%的患者最大减量率在每月减少 10%-40%之间，36.1%的患者每月减量率≥40%。在基线平均日剂量≥150 MME 的患者中，47.7%的患者最大减量率≥每月 40%。与基线相比，19.7%经历减量的患者在随访结束时每月的长期剂量减少≥40%。
高剂量长期阿片类药物治疗患者的剂量变化可能需要特别关注，尤其是在较短的时间间隔内，以了解如何在强调患者安全和共同决策的同时，减少潜在的突然减量和停药情况。阿片类药物的快速停药可能会增加不良后果的风险，包括阿片类药物戒断。
