Objective:

To examine the association of long-term opioid therapy (LTOT) tapering with the risk of substance use disorder (SUD) and overdose using a self-controlled design.

Approach:

• Study Design: Analyzed data from Optum’s Clinformatics® Data Mart Database for LTOT recipients from January 1, 2010, to December 31, 2021, using a self-controlled design to track individuals before and after taper onset.
• Opioid Dose and Tapering: Defined tapering as a ≥ 15% lower dose relative to a stable 90-day LTOT baseline, with separate analysis for abrupt discontinuation.
• Outcomes: Assessed substance-use-related morbidity through claims data for drug/medication overdose, opioid use disorder, or other non-tobacco SUD diagnoses.
• Statistical Analysis: Used conditional discrete-time logistic regression to estimate within-individual associations of SUD/overdose events during tapering relative to stable LTOT.

Key Findings:

• Tapering from LTOT was associated with increased risks of SUD and overdose compared to stable LTOT periods.
• Pre-existing factors may influence the risk of adverse outcomes during tapering.
• Higher doses and longer durations of LTOT may be associated with greater risks during tapering.

Interpretation:

Tapering from LTOT is associated with increased risks of SUD and overdose, with some risks potentially present before tapering begins.

Limitations:

• The study relies on claims data, which may not capture all substance use events.
• Potential confounding factors may still exist despite the self-controlled design.

Conclusion:

The study highlights the complexities of tapering LTOT and the associated risks with dose reductions.