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Opioid Dose Trajectories & 1-Year Outcomes

Long-term risks and benefits of opioid dose changes should be considered by clinicians and patients, authors conclude, based on a retrospective cohort study showing both positive and negative associations when opioid doses were decreasing or increasing.

Included in the analysis were 3,913 patients receiving long-term opioid therapy of 50–200 morphine milligram equivalents over a 3-year period in 2014–17 in 3 Colorado and Wisconsin health systems. Group-trajectory modeling revealed 5 dosing trajectories over 1 year ( 1 decreasing, 1 high-dose increasing, and 3 stable). Primary outcomes of the study after the trajectory period were  1-year all-cause mortality, incident opioid use disorder, continued opioid therapy at 1 year, and health plan disenrollment.

“Compared with stable trajectories, the decreasing dose trajectory was negatively associated with opioid use disorder (adjusted hazard ratio [aHR], 0.40; 95% CI, 0.29-0.55) and continued opioid therapy (site 1: adjusted relative risk [aRR], 0.39; 95% CI, 0.34-0.44), but was positively associated with health plan disenrollment (aHR, 1.66; 95% CI, 1.24-2.22),” the authors write. “The decreasing trajectory was not associated with mortality (aHR, 1.28; 95% CI, 0.87-1.86). In contrast, the high-dose increasing trajectory was positively associated with mortality (aHR, 2.19; 95% CI, 1.44-3.32) and opioid use disorder (aHR, 1.81; 95% CI, 1.39-2.37) but was not associated with disenrollment (aHR, 0.90; 95% CI, 0.56-1.42) or continued opioid therapy (site 1: aRR, 0.98; 95% CI, 0.94-1.03).”

Source: JAMA Network Open