Jama: opioid taper associated with increased overdose or suicide

[myrandom2003]

Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Opioids

This study examines whether there are associations between opioid dose tapering and subsequent rates of overdose and mental health crisis among patients prescribed stable, long-term, high-dose opioids.

jamanetwork.com

So the forced opioid taper to fall in line with guidelines is the damned if we do… getting in trouble with Johnny law for falling outside of guidelines is the damned if we don’t.

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[lobelsteve]

Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Opioids

This study examines whether there are associations between opioid dose tapering and subsequent rates of overdose and mental health crisis among patients prescribed stable, long-term, high-dose opioids.

jamanetwork.com

So the forced opioid taper to fall in line with guidelines is the damned if we do… getting in trouble with Johnny law for falling outside of guidelines is the damned if we don’t.

Meaning Opioid dose tapering was associated with increased risk for overdose and mental health crisis, but interpretation of these findings is limited by the study design.

So basically useless. Association is not causation. Anyone got full text? Reason for taper might be critical factor.

 

[bedrock]

Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Opioids

This study examines whether there are associations between opioid dose tapering and subsequent rates of overdose and mental health crisis among patients prescribed stable, long-term, high-dose opioids.

jamanetwork.com

So the forced opioid taper to fall in line with guidelines is the damned if we do… getting in trouble with Johnny law for falling outside of guidelines is the damned if we don’t.

Stable high dose opioid patient isn’t an accurate term here. I’ve seen plenty of patients that were stable on norco BID, but almost never a stable patient on >100 MME.

They always want more, but lately can’t find anyone to prescribe more to them.

 

[painfree23]

I hate papers like this. Create a problem without a solution. Maybe the title should have been -“highly recommended use of addictionologists for opiate tapers” bc the conclusion from this paper shouldn’t be don’t taper opiates .

 

[drusso]

I hate papers like this. Create a problem without a solution. Maybe the title should have been -“highly recommended use of addictionologists for opiate tapers” bc the conclusion from this paper shouldn’t be don’t taper opiates .

What if the opioids are working?

 

[deleted875186]

Stable high dose opioid patient isn’t an accurate term here. I’ve seen plenty of patients that were stable on norco BID, but almost never a stable patient on >100 MME.

They always want more, but lately can’t find anyone to prescribe more to them.

100%. Once over a certain MME, it’s useless.

Sometimes I wonder if the CDC went farther and flat out restricted anyone from going above 60 or 90 MMEs we would have been better off, as it stands now most of us won’t take over high doses without tapering, but there’s always a few PCPs and pain doctors in the area that are continuing these patients.

 

[lobelsteve]

100%. Once over a certain MME, it’s useless.

Sometimes I wonder if the CDC went farther and flat out restricted anyone from going above 60 or 90 MMEs we would have been better off, as it stands now most of us won’t take over high doses without tapering, but there’s always a few PCPs and pain doctors in the area that are continuing these patients.

Great resource to have for folks outside the lines. Glad someone is willing to see those patients.

 

[lobelsteve]

From the study:


Limitations
This study has several limitations. First, although it included a number of key covariates, unmeasured factors may have contributed to increased risk for adverse events in the population who underwent tapering. Nevertheless, the findings are consistent with recent studies of opioid discontinuation10-15,29,30 and were robust to adjustment for baseline overdose, mental health conditions, and a range of sensitivity analyses. Second, the analyses could not assess tapering circumstances. Recent evidence has shown that the majority of opioid tapering and discontinuation is clinician-initiated,31 and risks may differ with voluntary vs involuntary tapering.32,33 Third, the study design considered any dose reduction of greater than or equal to 15% of the baseline dose as a taper initiation but did not account for subsequent dose trajectory. Fourth, the data set lacked an accurate measure of race, limiting the ability to account for the potential differential opioid prescribing and tapering trends between racial and ethnic groups. Fifth, the data set does not measure illicit opioid use or account for methadone administered in certified treatment programs. Sixth, administrative claims data have inherent measurement error. Seventh, these data were claims from commercially-insured and Medicare Advantage patients in the US, and the generalizability of these findings is uncertain.

 

[drusso]

From the study:


Limitations
This study has several limitations. First, although it included a number of key covariates, unmeasured factors may have contributed to increased risk for adverse events in the population who underwent tapering. Nevertheless, the findings are consistent with recent studies of opioid discontinuation10-15,29,30 and were robust to adjustment for baseline overdose, mental health conditions, and a range of sensitivity analyses. Second, the analyses could not assess tapering circumstances. Recent evidence has shown that the majority of opioid tapering and discontinuation is clinician-initiated,31 and risks may differ with voluntary vs involuntary tapering.32,33 Third, the study design considered any dose reduction of greater than or equal to 15% of the baseline dose as a taper initiation but did not account for subsequent dose trajectory. Fourth, the data set lacked an accurate measure of race, limiting the ability to account for the potential differential opioid prescribing and tapering trends between racial and ethnic groups. Fifth, the data set does not measure illicit opioid use or account for methadone administered in certified treatment programs. Sixth, administrative claims data have inherent measurement error. Seventh, these data were claims from commercially-insured and Medicare Advantage patients in the US, and the generalizability of these findings is uncertain.

GIGO. Someone got tenure, promotion, and doctoral dissertation I hope. Take-offs and landings are risky. Usually, planes just don't fall out of the sky.

 

[deleted875186]

From the study:


Limitations
This study has several limitations. First, although it included a number of key covariates, unmeasured factors may have contributed to increased risk for adverse events in the population who underwent tapering. Nevertheless, the findings are consistent with recent studies of opioid discontinuation10-15,29,30 and were robust to adjustment for baseline overdose, mental health conditions, and a range of sensitivity analyses. Second, the analyses could not assess tapering circumstances. Recent evidence has shown that the majority of opioid tapering and discontinuation is clinician-initiated,31 and risks may differ with voluntary vs involuntary tapering.32,33 Third, the study design considered any dose reduction of greater than or equal to 15% of the baseline dose as a taper initiation but did not account for subsequent dose trajectory. Fourth, the data set lacked an accurate measure of race, limiting the ability to account for the potential differential opioid prescribing and tapering trends between racial and ethnic groups. Fifth, the data set does not measure illicit opioid use or account for methadone administered in certified treatment programs. Sixth, administrative claims data have inherent measurement error. Seventh, these data were claims from commercially-insured and Medicare Advantage patients in the US, and the generalizability of these findings is uncertain.

Limitations: everything about the study, but we feel it still should be published ….

 

[Ferrismonk]

Limitations: everything about the study, but we feel it still should be published ….

#AMA #JAMA

 

[kstarm]

So opioid tapering is causing mental health crisis or patients with mental health conditions are managing these conditions with opioids and taking them away is leading to less control...

 

[drusso]

So opioid tapering is causing mental health crisis or patients with mental health conditions are managing these conditions with opioids and taking them away is leading to less control...

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