The 2016 Centers for Disease Control and Prevention guideline on long-term opioid therapy suggests that primary care clinicians in outpatient settings consider tapering in patients in whom an individualized assessment determines that benefits of long-term opioid therapy do not outweigh risks. However, even when appropriate, tapering long-term opioid therapy can be a challenge. Patients may experience withdrawal symptoms, negative psychological effects, worsened pain, or serious adverse events (e.g., suicide or overdose) while undergoing taper, and may not reach tapering goals. Tapering may be more challenging in Medicare populations due to higher medical complexity, presence of disability, or older age. Therefore, effective treatments and technologies to support opioid tapers in this population could improve symptoms and increase the likelihood of tapering success, while reducing adverse outcomes.
- Systematic reviews found that interdisciplinary pain rehabilitation, behavioral health support, and buprenorphine-assisted tapering may be effective to reduce or discontinue long-term opioid therapy; pain, function, and quality of life may improve with opioid dose reduction in certain individuals, or populations. Buprenorphine is a partial opioid agonist that can treat pain effectively in certain patients, as well as opioid use disorders, and it has other properties including less opioid-induced hyperalgesia and easier withdrawal than full mu-agonist opioids, and less respiratory depression than other long-acting opioids. However, the quality of evidence is low or very low, and few studies specifically evaluated populations potentially eligible for Medicare.
- No study evaluated the effectiveness of technological solutions to support opioid tapering in patients with chronic pain, effectiveness of interventions to mitigate risks of overdose or suicide, or the ways benefits and harms of tapering support interventions vary in subgroups based on demographics or clinical factors.
- Observational studies found that opioid discontinuation might be associated with increased risk of overdose and suicide or suicidal ideation, but available studies did not evaluate the indication for discontinuing opioids, the tapering strategy used, or use of strategies for mitigating risk of overdose, suicide, or suicidal ideation, and were susceptible to confounding due to these factors.
Chou R, Eden K, Korthuis T, Merlin J, Dana T, Pappas M, Hart E. Treatments and Technologies Supporting Appropriate Opioid Tapers. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.) AHRQ Publication No. 21-EHC019. Rockville, MD: Agency for Healthcare Research and Quality; April 2021. doi: https://doi.org/10.23970/AHRQEPCOPIOIDWITHDRAWAL. Posted final reports are located on the Effective Health Care Program search page.