(076) Incidence of opioid dose tapering among older adults enrolled in Medicare

Background: Long-term opioid therapy (LTOT) is frequently used for the management of chronic non-cancer pain (CNCP), but its association with increased risks of overdose and mortality has necessitated an evaluation of strategies for tapering or discontinuation. The process of opioid tapering or discontinuation is difficult and complex due to associated withdrawal symptoms and potential adverse outcomes. Thus, understanding tapering patterns and associated factors is vital for optimizing pain management, especially for vulnerable older adults.

Objectives: This study aimed to examine the incidence and patterns of opioid dose tapering and characteristics associated with tapering in a nationally representative dataset of older adults enrolled in Medicare fee-for-service.

Methods: This cohort study used the 5% national sample of Medicare administrative claims data from 2012 to 2018. The study cohort consisted of individuals aged 65 and older on LTOT. The key outcomes were time until any tapering or rapid tapering of opioids. Various predictor variables, including sociodemographic and clinical factors, and the release of the 2016 CDC opioid prescribing guidelines were examined. Survival curves were plotted and Cox proportional hazards models were used for data analysis.

Results: Those eligible for cohort inclusion included 104,267 Medicare beneficiaries on LTOT, of which the majority were women (66.0%), non-Hispanic White (90.8%), and had multiple CNCP conditions (78.3%). Individuals had a 63.6% chance of being tapered and a 16.8% chance of experiencing rapid tapering for each year they were on LTOT. The presence of multiple CNCP conditions, hepatic impairment, sleep disorders, Parkinson’s disease, higher baseline opioid dose, and LTOT initiation after 2016 were associated with an increased rate of both any tapering, and rapid tapering. The release of the 2016 CDC guideline was associated with a 31% and 53% increase in the hazards of any tapering and rapid tapering, respectively.

Conclusions: This study estimated the incidence rate and predictors of different velocities of opioid tapering among older adults in the United States. Combined with rates of opioid prescribing and prevalence of chronic pain, these epidemiological data are crucial for identifying and improving the safety and effectiveness of pain management among older adults.