Patient outcomes after opioid dose reduction among patients with chronic opioid therapy : PAIN

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Patient outcomes after opioid dose reduction among patients with chronic opioid therapy

Hallvik, Sara E.a,*; El Ibrahimi, Sanaea,b; Johnston, Kirbeec; Geddes, Jonahc; Leichtling, Gilliana; Korthuis, P. Toddd; Hartung, Daniel M.c

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PAIN 163(1):p 83-90, January 2022. | DOI: 10.1097/j.pain.0000000000002298

The net effects of prescribing initiatives that encourage dose reductions are uncertain. We examined whether rapid dose reduction after high-dose chronic opioid therapy (COT) associates with suicide, overdose, or other opioid-related adverse events. This retrospective cohort study included Oregon Medicaid recipients with high-dose COT. Claims were linked with prescription data from the prescription drug monitoring program and death data from vital statistics, 2014 to 2017. Participants were placed into 4 mutually exclusive dose trajectory groups after the high-dose COT period, and Cox proportional hazard models were used to examine the effect of dose changes on patient outcomes in the following year. Of the 14,596 high-dose COT patients, 4191 (28.7%) abruptly discontinued opioid prescriptions, 1648 (11.3%) reduced opioid dose before discontinuing, 6480 (44.4%) had a dose reduction but never discontinued, and 2277 (15.6%) had a stable or increasing dose. Discontinuation, whether abrupt (adjusted hazard ratio [aHR] 3.63; 95% confidence interval [CI] 1.42-9.25) or with dose reduction (aHR 4.47, 95% CI 1.68-11.88) significantly increased risk of suicide compared with those with stable or increasing dose. By contrast, discontinuation or dose reduction reduced the risk of overdose compared with those with a stable or increasing dose (aHR 0.36–0.62, 95% CI 0.20-0.94). Patients with an abrupt discontinuation were more likely to overdose on heroin (vs. prescription opioids) than patients in other groups (P < 0.0001). Our study suggests that patients on COT require careful risk assessment and supportive interventions when considering opioid discontinuation or continuation at a high dose.


In this article by Hallvik et al.,1 which published in the January 2022 issue of PAIN, the authors request the following correction.

Reference 17 should be replaced by:

[17] James JR, Scott JM, Klein JW, Jackson S, McKinney C, Novack M, Chew L, Merrill JO. Mortality after discontinuation of primary care–based chronic opioid therapy for pain: a retrospective cohort study. Journal of General Internal Medicine 2019;34;2749–55.

The authors apologize for the error.

PAIN. 163(4):e613, April 2022.

© 2021 International Association for the Study of Pain

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