Slow down! Rapid opioid taper in long term users risks overdose or mental health crisis.

New evidence just published in JAMA underlines the complexity of managing opioid use disorder (OUD) in persons taking long term higher dose opioids.  The study reviewed medical and pharmacy records of more than 110,000 patients taking stable (at least 12 months), higher dose (at least 50 mg of morphine equivalent).   Patients who underwent opioid tapering - defined as a 15% or higher reduction in dose - were noted to have a nearly 68% increase in emergency room or hospital visits for overdose events and a more than doubling of visits for mental health crises including depression, anxiety or suicide attempt. 

There are sound medical indications for opioid tapering including the growing consensus that opioids lack efficacy for chronic pain. However, this study suggests tapering should be performed slowly - perhaps by 10% every 3 months - under careful clinician guidance with frequent follow-up. Stigmatized persons with OUD attempting self-taper are probably at even higher risk for overdose or mental health crisis. Employers should maintain lines of communication and check in frequently with employees dealing with SUD.