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

Autor:	Hallvik SE; Comagine Health, Research & Evaluation Department, Portland, OR, United States., El Ibrahimi S; Comagine Health, Research & Evaluation Department, Portland, OR, United States.; School of Public Health, Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, NV, United States., Johnston K; Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, OR, United States., Geddes J; Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, OR, United States., Leichtling G; Comagine Health, Research & Evaluation Department, Portland, OR, United States., Korthuis PT; Oregon Health & Science University, Portland, OR, United States., Hartung DM; Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, OR, United States.
Jazyk:	angličtina
Zdroj:	Pain [Pain] 2022 Jan 01; Vol. 163 (1), pp. 83-90.
DOI:	10.1097/j.pain.0000000000002298
Abstrakt:	Abstract: 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. (Copyright © 2021 International Association for the Study of Pain.)
Databáze:	MEDLINE
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