title: A chronic opioid therapy dose reduction policy in primary care.
abstract: BACKGROUND
  High-dose opioids prescribed for the treatment of chronic pain have been associated with increased risk of opioid overdose. Health systems and states have responded by developing opioid dose limitation policies. Little is known about how these policies affect prescribing practices or characteristics of patients who respond best to opioid tapers from high-dose opioids.
  
  
  METHODS
  We conducted a retrospective cohort study to evaluate change in total opioid dose after the implementation of a provider education intervention and a 120 mg morphine equivalents per day (MED) opioid dose limitation policy in one academic primary care clinic. We compared opioid prescriptions 1 year before and 1 year after the intervention. We used univariate and multivariate logistic regression to assess which patient characteristics predicted opioid dose reduction from high opioid dose.
  
  
  RESULTS
  Out of a total of 516 patients prescribed chronic opioid therapy, 116 patients (22%) were prescribed high-dose opioid therapy (>120 mg MED). After policy adoption, the average daily dose of opioids declined by 64 mg MED (95% confidence interval [CI]: 32-96; P < .001) and 41 patients (37%) on high-dose opioids tapered their doses below 120 mg MED (Tapered to Safer Dose group). In multivariate analyses, female sex was the only significant association with dose taper; female patients were less likely to taper to a safer dose (adjusted odds ratio [aOR] = 0.28, 95% CI: 0.11-0.70).
  
  
  CONCLUSIONS
  A combined intervention of education and a practice policy that limits opioid doses for patients prescribed chronic opioid therapy may be an important component of system-level strategies to reduce opioid misuse and overdose; it may also help identify patients suitable for medication-assisted treatment for opioid use disorder. Specific strategies may be needed to assist women with opioid dose tapers.
authors.affiliation: a Department of Medicine , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Weimer
authors.affiliation: b Oregon State University/Oregon Health & Science University College of Pharmacy , Portland , Oregon , USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Hartung
authors.affiliation: b Oregon State University/Oregon Health & Science University College of Pharmacy , Portland , Oregon , USA.
authors.forename: Sharia
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: a Department of Medicine , Oregon Health & Science University , Portland , Oregon , USA.|c Regional Research Institute, School of Social Work , Portland State University , Portland , Oregon , USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Nicolaidis
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy; D004334:Drug Administration Schedule; D062787:Drug Overdose / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic pain; chronic opioid therapy; morphine equivalent per day