Prepared by: Evidence Synthesis Program (ESP) Coordinating Center
Portland VA Health Care System
Mark Helfand, MD, MPH, MS, Director
Recommended Citation: Mackey K, Anderson J, Bourne D, Chen E, Peterson K. Evidence Brief: Benefits and Harms of Long-term Opioid Dose Reduction or Discontinuation in Patients with Chronic Pain. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-199; 2019.
The ESP Coordinating Center (ESP CC) is responding to a request from VA Health Services Research and Development Service (HSR&D) for an evidence brief on patient outcomes following long-term opioid dose reduction or discontinuation. Findings from this evidence brief will be used to inform prioritization of questions for a State-of-the-Art conference in September 2019.
Key Question 1: Among patients prescribed long-term opioid therapy for chronic pain, what are the benefits and harms of opioid dose reduction or discontinuation?
Key Question 2: Do the benefits and harms of opioid dose reduction or discontinuation vary by:
Patient co-morbidities (previously diagnosed substance use disorder or mental health diagnoses),
Indication for dose reduction or discontinuation (factors leading to the consideration of tapering in the first place such as patient preference, side effects, poorly controlled pain on opioids, concern for opioid misuse, change in health system or payer policy, or other reasons),
Patient engagement in tapering (including whether the taper is patient-initiated, collaboratively/patient-centered, or involuntary/mandated and unilaterally imposed),
Intent of taper (reduction to target dose vs discontinuation),
Baseline morphine equivalent daily dose (MEDD),
Opioid regimen (intermittent use vs daily use; long-acting vs short-acting opioid use), or
Taper characteristics (fast <1 month or slow >1 month; individualized or per protocol)?