Trends and Rapidity of Dose Tapering Among Patients Prescribed Long-term Opioid Therapy, 2008-2017
Open accessAbstract
Importance: A 2016 Centers for Disease Control and Prevention prescribing guideline cautioned against higher-dose long-term opioid therapy and recommended tapering daily opioid doses by approximately 10% per week if the risks outweigh the benefits. Warnings have since appeared regarding potential hazards of rapid opioid tapering. Objectives: To characterize US trends in opioid dose tapering among patients prescribed long-term opioids from 2008 to 2017 and identify patient-level variables associated with tapering and a more rapid rate of tapering. Design, Setting, and Participants: This retrospective cohort study used deidentified medical and pharmacy claims and enrollment records for 100 031 commercial insurance and Medicare Advantage enrollees, representing a diverse mixture of ages, races/ethnicities, and geographical regions across the United States. Adults with stable, higher-dosage (mean, ≥50 morphine milligram equivalents [MMEs]/d) opioid prescriptions for a 12-month baseline period and 2 or more months of follow-up from January 1, 2008, to December 31, 2017, were included in the study. Main Outcomes and Measures: Tapering was defined as 15% or more relative reduction in mean daily MME during any of 6 overlapping 60-day windows within a 7-month follow-up period. The rate of tapering was computed as the maximum monthly percentage dose reduction. Results: Among the 100 031 participants (53 452 [53.4%] women; mean [SD] age, 57.6 [11.8] years), from 2008 to 2015, the age- and sex-standardized percentage of patients tapering daily opioid doses increased from 10.5% to 13.7% (adjusted incidence rate ratio [aIRR] per year, 1.05 [95% CI, 1.05-1.06]) before increasing to 16.2% in 2016 and 22.4% in 2017 (aIRR in 2016-2017 vs 2008-2015, 1.20 [95% CI, 1.16-1.25]). Patient-level covariates associated with tapering included female sex (aIRR, 1.13 [95% CI, 1.10-1.15]) and higher baseline dose (aIRR for ≥300 MMEs/d vs 50-89 MMEs/d, 2.57 [95% CI, 2.48-2.65]). Among patients tapering daily opioid doses, the mean (SD) maximum dose reduction was 27.6% (17.0%) per month, and 18.8% of patients had a maximum tapering rate exceeding 40% per month (ie, faster than 10% per week). More rapid dose reduction was associated with 2016-2017 vs 2008-2015 (adjusted difference, 1.4% [95% CI, 0.8%-2.1%]) and higher baseline dose (adjusted difference, 2.7% [95% CI, 2.2%-3.3%] for 90-149 vs 50-89 MMEs/d). Conclusions and Relevance: Patients using long-term opioid therapy are increasingly undergoing dose tapering, particularly women and those prescribed higher doses; in addition, dose tapering has become more common since 2016. Many patients undergoing tapering reduce daily doses at a rapid maximum rate.
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In another analysis, only 13.7% of patients tapering opioids achieved complete cessation in a 9-year window.
“In another analysis, only 13.7% of patients tapering opioids achieved complete cessation in a 9-year window. 43”
From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [43]
The Results report that 13.7% was the percentage of patients tapering their daily opioid dose in 2015, not the percentage of tapering patients who stopped opioids. The Methods define tapering as a dose reduction of at least 15% during a seven-month follow-up, and the Limitations say the study did not evaluate whether reductions were sustained. No cessation rate over a nine-year window is reported in these passages. (LLM, conf=0.89)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredMore than a quarter of patients in a study of almost 100,000 were tapering at a rate faster than 40% of their original dose per month, even higher than the maximum rate recommended by the CDC.
“A study of almost 100,000 patients found that the average rate of tapering was 34.0% of the original dose per month and more than a quarter of patients were tapering at a rate faster than 40% of their original dose per month,43,49 even higher than the maximum rate recommended by the CDC. 1”
From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [43]
The Results report that 18.8% of tapering patients—not more than a quarter—had a maximum dose reduction rate exceeding 40% per month. They also give a mean maximum rate of 27.6% per month, not 34.0%. The Methods do support the comparison with the CDC guideline's recommended rate. (LLM, conf=0.93)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredA study of almost 100,000 patients found that the average rate of tapering was 34.0% of the original dose per month.
“A study of almost 100,000 patients found that the average rate of tapering was 34.0% of the original dose per month and more than a quarter of patients were tapering at a rate faster than 40% of their original dose per month,43,49 even higher than the maximum rate recommended by the CDC. 1”
From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [43]
The Results report a cohort of 100,031 patients, supporting the study-size description. But the reported mean maximum tapering rate was 27.6% per month, not 34.0%; the Results also say 18.8% exceeded 40% per month, not more than a quarter. Page numbers were not available in our copy. (LLM, conf=0.91)
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“…34.0% of the original dose per month and more than a quarter of patients were tapering at a rate faster than 40% of their original dose per month, 43,49 even higher than the maximum rate recommended by the CDC. 1 Another study in China had similar findings: with 50.4% of patients tapered faster…”
Influential
- Authors
- Fenton, J. J., Agnoli, A. L., Xing, G., Hang, L., Altan, A. E., Tancredi, D. J., Jerant, A., & Magnan, E.
- Affiliations
- University of California, Davis (US)
- OptumLabs, Cambridge, Massachusetts
- Corresponding author
- Fenton, Joshua J.
- ORCID
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2019-11-15
- Volume
- 2
- Issue
- 11
- Pages
- e1916271
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC6902834
- OpenAlex
- W2986258467
- Cited by
- 97
- References
- 34
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 11 · 2023: 14 · 2022: 21 · 2021: 17 · 2020: 11
- FWCI
- 11.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- University of California, Davis
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K12AR084220)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD051958)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- long-term opioid therapy, opioid prescribing trends, morphine milligram equivalents, sex differences, chronic pain management, opioid prescribing guidelines, Medicare Advantage enrollees, opioid overdose risk, opioid use disorder risk, opioid-related deaths
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Analgesics, Opioid, Female, Medicare, Humans, Male, Middle Aged, Practice Patterns, Physicians', Retrospective Studies, Sex Factors, United States, Young Adult
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