Prescription Opioid Dose Reductions and Potential Adverse Events: a Multi-site Observational Cohort Study in Diverse US Health Systems

• Published in: Journal of general internal medicine : JGIM 2024-05, Vol.39 (6), p.1002-1009
• Main Authors: Metz, Verena E., Ray, G. Thomas, Palzes, Vanessa, Binswanger, Ingrid, Altschuler, Andrea, Karmali, Ruchir N., Ahmedani, Brian K., Andrade, Susan E., Boscarino, Joseph A., Clark, Robin E., Haller, Irina V., Hechter, Rulin C., Roblin, Douglas W., Sanchez, Katherine, Bailey, Steffani R., McCarty, Dennis, Stephens, Kari A., Rosa, Carmen L., Rubinstein, Andrea L., Campbell, Cynthia I.
• Format: Article
• Language: English
• Subjects: Adult; Adverse events; Aged; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Benzodiazepines; Benzodiazepines - administration & dosage; Benzodiazepines - adverse effects; Buprenorphine; Clinical trials; Cohort analysis; Cohort Studies; Drug dosages; Drug overdose; Drug Tapering; Electronic health records; Electronic medical records; Emergency medical care; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Morphine; Mortality; Narcotics; Observational studies; Opiate Overdose - epidemiology; Opiate Overdose - mortality; Opioids; Original Research; Overdose; Prescription drugs; Regression analysis; United States - epidemiology; Young Adult
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-023-08459-y

Background In response to the opioid crisis in the United States, population-level prescribing of opioids has been decreasing; there are concerns, however, that dose reductions are related to potential adverse events. Objective Examine associations between opioid dose reductions and risk of 1-month potential adverse events (emergency department (ED) visits, opioid overdose, benzodiazepine prescription fill, all-cause mortality). Design This observational cohort study used electronic health record and claims data from eight United States health systems in a prescription opioid registry (Clinical Trials Network-0084). All opioid fills (excluding buprenorphine) between 1/1/2012 and 12/31/2018 were used to identify baseline periods with mean morphine milligram equivalents daily dose of  ≥ 50 during six consecutive months. Patients We identified 60,040 non-cancer patients with  ≥ one 2-month dose reduction period (600,234 unique dose reduction periods). Main Measures Analyses examined associations between dose reduction levels (1–