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Discontinuing Long-Term Opioids Tied to Overdose Risk

Tapering cuts risk for overdose among those with opioid use disorder

THURSDAY, Dec. 8, 2022 (HealthDay News) — Discontinuing prescribed opioids in people with chronic pain is associated with increased overdose risk, according to a study published online Dec. 1 in PLOS Medicine.

Mary Clare Kennedy, Ph.D., from the University of British Columbia-Okanagan in Kelowna, Canada, and colleagues used a 20 percent random sample of residents in the provincial health insurance client roster to identify 14,037 persons aged 14 to 74 years on long-term opioid therapy for pain (≥90 days).

The researchers found that during a median 3.7 years of follow-up, discontinuing opioids (at least seven-day gap[s] in therapy) was associated with increased overdose risk among people without opioid use disorder (OUD; adjusted hazard ratio [aHR], 1.44), people with OUD not receiving opioid agonist therapy (OAT; aHR, 3.18), and people with OUD receiving OAT (aHR, 2.52), after adjusting for a range of demographic, prescription, comorbidity, and social-structural exposures. Among people with OUD not receiving OAT, opioid tapering (two or more sequential decreases of ≥5 percent in average daily morphine milligram equivalents) was associated with decreased overdose risk (aHR, 0.31).

“These findings point to the need to avoid abrupt discontinuation of opioid treatment for pain and to enhance guidance for prescribers in modifying opioid treatment tapering strategies on the basis of OUD and OAT status,” the authors write.

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