PhD Candidate Monash Addiction Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University Melbourne, Australia
Background: Tapering opioids for patients with chronic non-cancer pain may improve pain, function and quality of life. However, abrupt discontinuation may pose new risks such as uncontrolled pain, suicidal attempts and overdose.
Objectives: To determine differing opioid tapering trajectories among patients prescribed opioid analgesics for at least 6 months, and examine patient-level characteristics associated with different trajectories.
Methods: We used a primary care dataset from 464 Victorian general practices, consisting of almost 700,000 de-identified patient records where opioid analgesics were prescribed. Using the data, we identified patients prescribed continuous, stable dose of opioid analgesics for at least 6 months between January 2016 and September 2019. We examined opioid doses for 12 months from commencement of a taper following a 6-month baseline period. Taper was defined as a minimum of 10% reduction in the average opioid dose over a 90-day period compared to the average dose during the baseline period. Group-based trajectory modelling was conducted to determine opioid taper trajectories. Multinomial logistic regression analysis was performed to examine predictors of different taper trajectories.
Results: A total of 3,371 out of 8,645 patients on long-term opioids commenced a taper. Among these patients, six distinct opioid taper trajectory groups were identified, including three successful discontinuation trajectories and three non-completed taper trajectories. A successful discontinuation trajectory from high opioid doses was not identified. For patients prescribed medium doses, compared to those that didn’t complete taper (30.4%), those that successfully tapered were more likely to have higher geographically-derived socio-economic status (relative risk ratio [RRR], 1.067; 95% confidence interval [CI], 1.001-1.137) and less likely to have sleep disorders (RRR, 0.661; 95% CI, 0.463-0.945). Patients who didn’t complete taper were more likely to be prescribed strong opioids, regardless of whether they were tapered from low doses (RRR, 1.441; 95% CI, 1.137-1.828) or high doses (RRR, 1.344; 95% CI, 1.027-1.760). Patients with non-completed taper starting from high doses were more likely to have depression and/or anxiety (RRR, 1.353; 95% CI, 1.051-1.743) and less likely to be aged ≥85 (RRR, 0.345; 95% CI, 0.200-0.596) compared to those with non-completed taper starting from a medium dose.
Conclusions: Patients with higher geographically-derived socio-economic status and no diagnosis of sleep disorders appear more likely to complete opioid tapers. Those prescribed strong opioids and high doses appear less likely to complete taper, and warrant additional support and monitoring during taper.
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