ArticleDrug and alcohol dependence2020
The Association between Opioid Discontinuation and Heroin Use: A Nested Case-Control Study.
Article in Drug and alcohol dependence, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 2 syntheses or guidelines pooled it, 52 citations in OpenAlex.
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2022Guideline
- Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2022Pooled it
- "Safer supply is the thing that changes everything": the role of prescribed safer supply in rebuilding trust following experiences of medical abandonment.BMC public health · 2026Article
- Development and Validation of an Electronic Health Record-Based Algorithm for Identifying Patients With Long-Term Opioid Therapy: Cross-Sectional Study.Journal of medical Internet research · 2025Article
- Integrating PRISM with User-centered Design (PRISM+UCD): Designing clinical decision support for safe opioid prescribing.Research square · 2025Article
- Association between rapid opioid reduction or discontinuation and self-harm, suicide attempt, and suicide death among patients receiving high-dose, long-term opioid therapy in North Carolina, 2006-2018.American journal of epidemiology · 2025Article
- Receipt of addiction treatment after nonfatal opioid overdose and risk of subsequent overdose: A retrospective cohort study.Drug and alcohol dependence · 2025Article
- Association of Pharmacologic and Nonpharmacologic Management of Acute Low Back Pain with Overdose Hospitalizations: A Nested Case-Control Study.Journal of integrative and complementary medicine · 2025Article
- De-prescribing opioids among Medicaid patients with long-term opioid use.Journal of substance use and addiction treatment · 2025Article
- Impact of State Policies on Opioid Prescribing Among Surgery and Injury Patients: Controlled Interrupted Time-Series Study, North Carolina, 2014-2019.Pharmacoepidemiology and drug safety · 2025Article
- Association of opioid tapering with pain-related emergency department visits, hospitalizations, and primary care visits: a retrospective cohort study.Pain medicine (Malden, Mass.) · 2025Article
- Sociogeographic determinants of rapid opioid reduction or discontinuation among patients on high-dose long-term opioid therapy in North Carolina, 2006-2018.Pain medicine (Malden, Mass.) · 2025Article
- Pharmacological Strategies to Decrease Long-Term Prescription Opioid Use: A Systematic Review.Journal of clinical medicine · 2024Review
- Are opioids effective analgesics and is physiological opioid dependence benign? Revising current assumptions to effectively manage long-term opioid therapy and its deprescribing.British journal of clinical pharmacology · 2024Review
- Patterns of gabapentinoid use among long-term opioid users.Preventive medicine · 2024Article
- Discontinuation of psychotropic medication: a synthesis of evidence across medication classes.Molecular psychiatry · 2024Review
- Implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia: A mixed methods study.Journal of substance use and addiction treatment · 2024Article
- Prescription Opioid Dose Reductions and Potential Adverse Events: a Multi-site Observational Cohort Study in Diverse US Health Systems.Journal of general internal medicine · 2024Observational
- Overlooking the obvious: the importance of communicating safety and risks of opioids-the Israeli context.Frontiers in pharmacology · 2024Article
- Factors Associated With Abrupt Discontinuation of Long-Term High-Dose Opioid Treatment.JAMA network open · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundOpioid prescribing guidelines recommend reducing or discontinuing opioids for chronic pain if harms of opioid treatment outweigh benefits. As opioid discontinuation becomes more prevalent, it is important to understand whether opioid discontinuation is associated with heroin use. In this study, we sought to assess the association between opioid discontinuation and heroin use documented in the medical record.
methodsA matched nested case-control study was conducted in an integrated health plan and delivery system in Colorado. Patients receiving opioid therapy in the study period (January 2006-June 2018) were included. Opioid discontinuation was defined as ≥45 days with no opioids dispensed after initiating opioid therapy. The heroin use onset date represented the index date. Case patients were matched to up to 20 randomly selected patients without heroin use (control patients) by age, sex, calendar time, and time between initiating opioid therapy and the index date. Conditional logistic regression models estimated matched odds ratios (mOR) for the association between an opioid discontinuation prior to the index date and heroin use.
resultsAmong 22,962 patients prescribed opioid therapy, 125 patients (0.54%) used heroin after initiating opioid therapy, of which 74 met criteria for inclusion in the analysis. The odds of opioid discontinuation were approximately two times higher in case patients (n = 74) than control patients (n = 1045; mOR = 2.19; 95% CI 1.27-3.78).
conclusionsAmong patients prescribed chronic opioid therapy, the observed increased risk for heroin use associated with opioid discontinuation should be balanced with potential benefits.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.