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Cited by 33Opioid Use Disorder TreatmentPain Management and Opioid UseAnesthesia and Pain Management

Factors associated with opioid-tapering success: A mixed methods study

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Kuntz, Jennifer L., Dickerson, John F., Schneider, Jennifer L., Firemark, Alison J., Papajorgji-Taylor, Dea, Slaughter, Matthew, Reese, Katherine R., Thorsness, Lou Ann +3 more·2021·Journal of the American Pharmacists Association
DOI 10.1016/j.japh.2020.12.019PMC PMC8127339
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Abstract

Objective Opioid tapering is recommended when risks of chronic opioid use outweigh benefits. Little is known about patient characteristics or factors related to tapering success. We sought to identify characteristics that predict a 50% reduction in opioid use and qualitatively characterize factors that impact tapering success.Methods We used multilevel hierarchical modeling to identify predictors of a 50% reduction in opioid use among Kaiser Permanente Northwest patients who underwent pharmacist-led tapering between 2012 and 2017. We conducted qualitative interviews among patients and pharmacists to identify factors influencing tapering success.Results We identified 1384 patients who, on average, were dispensed 207 milligram morphine equivalents per day at baseline. After 12 months, 56% of patients reduced their opioid use by 50%. Increased odds of 50% reduction were associated with younger age 21-49 years (Odds ratio [OR] 1.32, P = 0.004); previous surgery (OR 2.24, P < 0.001); increased number of Addiction Medicine encounters (OR 1.25, P = 0.011); substance use disorder (OR 1.62, P = 0.001); anxiety (OR 1.32, P = 0.003); non-narcotic analgesic (OR 1.22, P = 0.025) or antipsychotic medication use (OR 1.53, P = 0.006); and opioid days supplied in the previous year (OR 1.08, P < 0.001). Patients and pharmacists noted that success was influenced by patients' willingness or resistance to change opioid use, the level of patient engagement achieved through communication with their provider, aspects of the tapering process such as pace, and external factors including health issues or caregiving responsibilities.Conclusions Over one-half of patients who underwent tapering reduced their opioid use by 50%. Patient demographic and clinical characteristics were predictive of tapering success; however, patients and pharmacists noted that patient willingness, motivation, and personal circumstances also influence tapering outcome. Opioid tapering requires an individualized approach. Both clinical factors and personal circumstances should be considered when opioid tapering is being discussed as a possible solution for a patient.

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  • Patient willingness, motivation, level of engagement and personal circumstances have been noted to increase cessation.

    “Other important aspects that have been noted to increase cessation are patient willingness, motivation, level of engagement and personal circumstances. 54”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [54]

    The Qualitative Results and Discussion identify willingness, motivation, engagement, and personal circumstances as factors that may affect opioid-tapering success. But the study’s primary outcome was a 50% reduction in opioid use, not cessation, and its Conclusion says the findings do not prove that changing these factors changes the outcome. The claim overstates both the outcome and the evidence for an increase. (LLM, conf=0.88)

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Authors
Kuntz, J. L., Dickerson, J. F., Schneider, J. L., Firemark, A. J., Papajorgji-Taylor, D., Slaughter, M., Reese, K. R., Thorsness, L. A., Sullivan, M. D., Debar, L. L., & Smith, D. H.
Affiliations
  • Kaiser Permanente (US)
  • University of Washington (US)
  • Kaiser Permanente Washington Health Research Institute (US)
Corresponding author
Kuntz, Jennifer L.
ORCID
Venue
Journal of the American Pharmacists Association
Publisher
Elsevier BV
Published
2021-05
Volume
61
Issue
3
Pages
248-257.e1
ISSN
1544-3191 (ISSN-L)
DOI
10.1016/j.japh.2020.12.019
PMC
PMC8127339
OpenAlex
W3117392406
Cited by
33
References
41
Citations by year
2026: 1 · 2025: 16 · 2024: 6 · 2023: 6 · 2022: 3 · 2021: 1
FWCI
3.46
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Pharmacists Association (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
Office of Extramural Research, National Institutes of Health
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 › Surgery › Anesthesia and Pain Management
Keywords
opioid tapering, chronic opioid use, opioid use reduction, substance use disorders, addiction medicine, patient motivation, patient engagement, non-opioid analgesics, antipsychotic drugs, morphine milligram equivalents, Kaiser Permanente
MeSH terms
Adult, Analgesics, Opioid, Communication, Humans, Middle Aged, Opioid-Related Disorders, Patient Participation, Pharmacists, Young Adult

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