Incidence of Opioid Dose Tapering Among Older Adults Enrolled in Medicare.

Abstract

Background and objectives: Long-term opioid therapy (LTOT) is frequently used for management of chronic noncancer pain, but its associations with increased risks of overdose and mortality have necessitated an evaluation of strategies for tapering or discontinuation. The process of opioid tapering is complex due to associated withdrawal symptoms and potential adverse outcomes. Thus, understanding tapering patterns and associated factors is vital for optimizing pain management, especially for vulnerable older adults.

Research design and methods: This cohort study used the 5% national sample of Medicare administrative claims data from 2012 to 2019. The study cohort consisted of individuals aged 65 and older on LTOT. The key outcomes were time until any tapering or rapid tapering of opioids. Various predictor variables, including sociodemographic and clinical factors, were examined. Survival curves were plotted, and Cox proportional hazards models were used for data analysis.

Results: The study cohort included 146,605 Medicare beneficiaries on LTOT, of which the largest percentages were aged 65-74 years (48.5%), women (68.0%), and non-Hispanic White (82.3%). Within the first year of LTOT use, nearly 1 in 2 individuals experienced any tapering, and about 1 in 4 individuals experienced rapid tapering. Presence of multiple chronic noncancer pain conditions, hepatic impairment, sleep disorders, higher baseline opioid dose, and LTOT initiation after 2016 were associated with increased rate of both any tapering and rapid tapering. The release of the 2016 CDC guideline was associated with a 45% and 64% increase in the hazards of any tapering and rapid tapering, respectively.

Discussion and implications: This study estimated the incidence rate and predictors of opioid tapering among older adults in the United States. Combined with rates of opioid prescribing and prevalence of chronic pain, these epidemiological data are crucial for identifying and improving the safety and effectiveness of pain management among older adults.