Pain-Related Healthcare Utilization Associated with Opioid Tapering

Context: Tapering of long-term opioid therapy (LTOT) increased after publication the 2016 CDC guidelines, followed by anecdotal reports exacerbated pain among tapered patients. However, two systematic reviews limited evidence from multidisciplinary control programs found similar or better ratings tapering versus baseline. Objective: To evaluate association between dose and subsequent emergency (ED) visits, outpatient primary care visits hospitalizations for patients prescribed LTOT. Study Design: Retrospective cohort study. Dataset: 2015-2019 de-identified administrative data Optum Labs Data Warehouse, including medical pharmacy claims eligibility information commercial Medicare Advantage enrollees, representing a mixture ages geographical regions. Population: Adults ≥18 years old who were stable doses LTOT ≥50 morphine milligram equivalents per day during 12-month baseline period Outcome Measures: Monthly counts ED up to 12 months entry. Pain defined diagnostic codes musculoskeletal other specific chronic in position on hospitalization claims, any visit claims. Analysis: modeled using negative binomial regression as function (≥15% relative reduction 6 overlapping 60-day periods entry), total non-pain hospitalizations, adjusted patient level-covariates (sociodemographics, comorbidities). Results: Among 51,361 LTOT, 14,331 (27.9%) was associated with more (adjusted incidence rate ratio [aIRR] 1.18, 95% CI: 1.11-1.27) fewer (aIRR 0.95, 0.92-0.99) pain. Hospitalizations unchanged 1.04, 0.95-1.15). Conclusions: subsequently yet pain, suggesting shift higher acuity setting post-taper. The findings suggest may have led disruption relationships, some combination these effects.