Taper KOLs are going to be pissed...

[drusso]

Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering

This cohort study assesses the longer-term risks of overdose or mental health crisis associated with opioid dose tapering.

jamanetwork.com

Original Investigation Pharmacy and Clinical Pharmacology

June 13, 2022

Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering

Joshua J. Fenton, MD, MPH1,2; Elizabeth Magnan, MD, PhD1,2; Irakis Erik Tseregounis, PhD3; et alGuibo Xing, PhD2; Alicia L. Agnoli, MD, MPH, MHS1,2; Daniel J. Tancredi, PhD2,4

Author Affiliations Article Information
JAMA Netw Open. 2022;5(6):e2216726. doi:10.1001/jamanetworkopen.2022.16726
editorial comment icon Editorial
Comment
Key Points
Question Is opioid dose tapering associated with reduced longer-term risks of overdose, withdrawal, or mental health crisis in patients prescribed long-term opioids?

Findings In this cohort study of 19 377 patients, in a posttaper period (beginning at least 12 months and extending up to 24 months after taper initiation) vs the pretaper period, the adjusted incidence rate ratios were 1.57 for overdose-withdrawal and 1.52 for a mental health crisis. Both were significant.

Meaning These findings suggest that opioid dose tapering was associated increased risks of overdose-withdrawal and mental health crisis that persisted up to 2 years after taper initiation.

Abstract
Importance Patients prescribed long-term opioid therapy are increasingly undergoing dose tapering. Recent studies suggest that tapering is associated with short-term risks of substance misuse, overdose, and mental health crisis, although lower opioid dose could reduce risks of adverse events over the longer term.

Objective To assess the longer-term risks of overdose or mental health crisis associated with opioid dose tapering.

Design, Setting, and Participants This is a cohort study using an exposure-crossover analysis. Data were obtained from the OptumLabs Data Warehouse, which includes deidentified medical and pharmacy claims and enrollment records for commercial insurance and Medicare Advantage enrollees, representing a diverse mixture of ages, races, ethnicities, and geographical regions across the US. Participants were US adults who underwent opioid dose tapering from 2008 to 2017 after a 12-month baseline period of stable daily dosing of 50 morphine milligram equivalents or higher and who had at least 1 month of long-term follow-up during a postinduction period beginning 12 months after taper initiation. Data analysis was performed from October 2021 to April 2022.

Exposures Opioid tapering, defined as 15% or more relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period after the stable baseline period.

Main Outcomes and Measures Emergency or hospital encounters for drug overdose or withdrawal and mental health crisis (depression, anxiety, or suicide attempt). Outcome counts were assessed in pretaper and postinduction periods (from 12 to 24 months after taper initiation).

Results The study included 21 515 tapering events among 19 377 patients with a mean (SD) of 9.1 (2.7) months of postinduction follow-up per event (median [IQR], 10 [8-11] months). Patients had a mean (SD) age of 56.9 (11.2) years, 11 581 (53.8%) were female, and 8217 (38.2%) had commercial insurance (vs Medicare Advantage). In conditional negative binomial regression analyses, adjusted incidence rate ratios for the postinduction period compared with the pretaper period were 1.57 (95% CI, 1.42-1.74) for overdose or withdrawal and 1.52 (95% CI, 1.35-1.71) for mental health crisis.

Conclusions and Relevance These findings suggest that opioid tapering was associated with increased rates of overdose, withdrawal, and mental health crisis extending up to 2 years after taper initiation.

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[callmeanesthesia]

Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering

This cohort study assesses the longer-term risks of overdose or mental health crisis associated with opioid dose tapering.

jamanetwork.com

Original Investigation Pharmacy and Clinical Pharmacology

June 13, 2022

Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering

Joshua J. Fenton, MD, MPH1,2; Elizabeth Magnan, MD, PhD1,2; Irakis Erik Tseregounis, PhD3; et alGuibo Xing, PhD2; Alicia L. Agnoli, MD, MPH, MHS1,2; Daniel J. Tancredi, PhD2,4

Author Affiliations Article Information
JAMA Netw Open. 2022;5(6):e2216726. doi:10.1001/jamanetworkopen.2022.16726
editorial comment icon Editorial
Comment
Key Points
Question Is opioid dose tapering associated with reduced longer-term risks of overdose, withdrawal, or mental health crisis in patients prescribed long-term opioids?

Findings In this cohort study of 19 377 patients, in a posttaper period (beginning at least 12 months and extending up to 24 months after taper initiation) vs the pretaper period, the adjusted incidence rate ratios were 1.57 for overdose-withdrawal and 1.52 for a mental health crisis. Both were significant.

Meaning These findings suggest that opioid dose tapering was associated increased risks of overdose-withdrawal and mental health crisis that persisted up to 2 years after taper initiation.

Abstract
Importance Patients prescribed long-term opioid therapy are increasingly undergoing dose tapering. Recent studies suggest that tapering is associated with short-term risks of substance misuse, overdose, and mental health crisis, although lower opioid dose could reduce risks of adverse events over the longer term.

Objective To assess the longer-term risks of overdose or mental health crisis associated with opioid dose tapering.

Design, Setting, and Participants This is a cohort study using an exposure-crossover analysis. Data were obtained from the OptumLabs Data Warehouse, which includes deidentified medical and pharmacy claims and enrollment records for commercial insurance and Medicare Advantage enrollees, representing a diverse mixture of ages, races, ethnicities, and geographical regions across the US. Participants were US adults who underwent opioid dose tapering from 2008 to 2017 after a 12-month baseline period of stable daily dosing of 50 morphine milligram equivalents or higher and who had at least 1 month of long-term follow-up during a postinduction period beginning 12 months after taper initiation. Data analysis was performed from October 2021 to April 2022.

Exposures Opioid tapering, defined as 15% or more relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period after the stable baseline period.

Main Outcomes and Measures Emergency or hospital encounters for drug overdose or withdrawal and mental health crisis (depression, anxiety, or suicide attempt). Outcome counts were assessed in pretaper and postinduction periods (from 12 to 24 months after taper initiation).

Results The study included 21 515 tapering events among 19 377 patients with a mean (SD) of 9.1 (2.7) months of postinduction follow-up per event (median [IQR], 10 [8-11] months). Patients had a mean (SD) age of 56.9 (11.2) years, 11 581 (53.8%) were female, and 8217 (38.2%) had commercial insurance (vs Medicare Advantage). In conditional negative binomial regression analyses, adjusted incidence rate ratios for the postinduction period compared with the pretaper period were 1.57 (95% CI, 1.42-1.74) for overdose or withdrawal and 1.52 (95% CI, 1.35-1.71) for mental health crisis.

Conclusions and Relevance These findings suggest that opioid tapering was associated with increased rates of overdose, withdrawal, and mental health crisis extending up to 2 years after taper initiation.

All the more reason to never start them on it in the first place, and never take over someone else’s mess.

 

[deleted472101]

Why is the title taper KOLs? There are probably a lot of physicians who are tapering that are not Key Opinion Leaders…

 

[lobelsteve]

They have all been tapered to 90 or less over the last 8 years.

 

[Ducttape]

repeating callmeanesthesia's post because it is so important:

Dont start opioids for chronic noncancer nonpalliative care.

 

[drusso]

Why is the title taper KOLs? There are probably a lot of physicians who are tapering that are not Key Opinion Leaders…

There's a whole cottage industry of physicians who have made careers, gotten promotions, taken government grant money, done expert witness work, etc in the interest of advancing taper agendas. If I were one of them and saw this paper, I'd be pissed...

 

[deleted472101]

Still not sure why KOLs is in the title but I would say that the people who were tapered probably were offered opiates for inappropriate reasons and also were offered other treatment options (not just interventional or surgery)

 

[Ducttape]

i suspect more it is an attempt to demonize those who have advocated tapering opioids into the same class as those who espouse unproven interventional spine surgery procedures/hardware implantation...

 

[drusso]

i suspect more it is an attempt to demonize those who have advocated tapering opioids into the same class as those who espouse unproven interventional spine surgery procedures/hardware implantation...

There cannot be two standards of proof.

 

[ateria radicularis magna]

i suspect more it is an attempt to demonize those who have advocated tapering opioids into the same class as those who espouse unproven interventional spine surgery procedures/hardware implantation...

I suspect the same.

 

[lobelsteve]

Oregon's drug decriminalization effort a 'tragedy'

In November 2020, Oregonians voted overwhelmingly to decriminalize possession of a small amount of hard drugs. Sixteen months in, the results paint a picture of failure.

www.foxnews.com

It is all Oregon's fault......

 

[drusso]

I suspect the same.

It's just human nature....a KOL doubles down on a narrative that X is good or Z is bad and starts a new professional society, advocacy group, etc. They market their ideas and attract the support of regulators and insurance companies. They become influencers and luminaries in the eyes of their peers. They begin to pad their resumes with papers, talks, conferences, and special panels; they get raises and promotions at their institutions, then they get grants, etc. It all feeds one machine. They become "an expert" and now are getting big money to give opinions and consult with groups, hospitals, regulators, etc. They fund their 401K's, their kid's 529's, etc plying their ideas and opinions...then it begins to crumble and fall. I'd be pissed. Very, very pissed.

 

[Ferrismonk]

JAMA is aimed at NPs and PCPs. No surprise they publish an article that says treating with opioids is better than taper.

 

[kstarm]

I thought this was old news....Tapering is a time that poses risk to the patient especially if done abruptly. I guess I must be missing the point here, this does nothing to say that tapering is inappropriate just that it carries risks. Just like being on chronic opioids carries risks. Doctors need to determine which is more risky and provide treatment options. I can't name a taper KOL, but I can't see how this would give them pause. If anything I think they would see this article as supporting: "Look how many people are treating mental health issues with opioids, rather than more appropriate and safe treatments." "Look at how many people have an underlying drug use issue, that was being put in check by opioids."

 

[drusso]

I thought this was old news....Tapering is a time that poses risk to the patient especially if done abruptly. I guess I must be missing the point here, this does nothing to say that tapering is inappropriate just that it carries risks. Just like being on chronic opioids carries risks. Doctors need to determine which is more risky and provide treatment options. I can't name a taper KOL, but I can't see how this would give them pause. If anything I think they would see this article as supporting: "Look how many people are treating mental health issues with opioids, rather than more appropriate and safe treatments." "Look at how many people have an underlying drug use issue, that was being put in check by opioids."

Taper KOL or Prophet?

 

[hyperalgesia]

This study cohort apparently includes all pts who were forced to taper because of abuse, diversion, suicide attempts, etc. It's completely shocking that this cohort was found to be more likely to experience issues after tapering. /s

"Association" = correlation. Association =/= causation.

 

[au bon pain]

My kid is screaming his head off in the background so my thinking may be off, but…

look at table 3, CI crosses 1 many, many times when stratified by MME.

And seems like they aggregate all the data to achieve their P value. Smells of stasticists shenanigans.

Seems that according to their paper I can taper someone from 80mme to zero without risk.


Or maybe it’s my kid melting down and I’m missing something