Evidence map›Paper›PMID 40261495›Full record

ArticleJournal of general internal medicine2025

Opioid Tapering and Opioid Overdose, Opioid Use Disorder, and Mortality Among Older Adults: A Nested Case-Control Study.

Yi Yang, Prachi Prajapati, Sujith Ramachandran, Kaustuv Bhattacharya, Shadi Bazzazzadehgan, Shishir Maharjan, Ike Eriator, John P Bentley

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Yi YangDepartment of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA. yiyang@olemiss.edu.ORCID 0000-0003-1575-5257
Prachi PrajapatiDepartment of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA.
Sujith RamachandranDepartment of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA.
Kaustuv BhattacharyaDepartment of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA.
Shadi BazzazzadehganDepartment of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA.
Shishir MaharjanDepartment of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA.
Ike EriatorDepartment of Anesthesiology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
John P BentleyDepartment of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA.

Funding

Safety and Effectiveness of Opioid Tapering among Older AdultsR15DA046036 · NIDA · UNIVERSITY OF MISSISSIPPI · PI YANG, YI · 2018 to 2022
$875k
NIDA NIH HHS R15 DA046036NIDA NIH HHS R15DA046036
6 · The paper itself

Abstract

backgroundOpioid tapering has increased in recent years; however, evidence regarding its safety profile is lacking.

objectiveTo examine the relationships between opioid tapering and subsequent overdose (OD), opioid use disorder (OUD), and all-cause mortality among older adults on long-term opioid therapy (LTOT).

designNested case-control design.

participantsA cohort of older (≥ 65 years) Medicare beneficiaries with chronic non-cancer pain who were on LTOT was identified from 2012-2020 5% national Medicare claims data. MAIN MEASURES: The key independent variable was rate of opioid tapering, operationalized as a monthly dose change percentage with four levels: steady dose (± 10% dose change), slow tapering (10-40% dose reduction), rapid tapering (> 40% dose reduction), and dose escalation (> 10% dose increase). The outcome variables were OD, OUD, and all-cause mortality. Conditional logistic regression was conducted on matched samples to evaluate the associations between opioid tapering and the outcomes. KEY

resultsAmong a cohort of 82,295, 1333 cases of OD, 4933 cases of OUD, and 5971 cases of all-cause mortality were identified. In primary analyses, after controlling for all covariates, compared with steady dose, the odds of OD were significantly lower (aOR = 0.74; 95% CI = 0.55-0.99) for rapid tapering and significantly higher (aOR = 2.08; 95% CI = 1.64-2.65) for dose escalation. Compared to steady dose, the odds of OUD were significantly lower (aOR = 0.53; 95% CI = 0.46-0.60) for rapid tapering and significantly higher (aOR = 1.60; 95% CI = 1.42-1.81) for dose escalation. Compared to steady dose, significantly higher odds for all-cause mortality were found among patients undergoing rapid tapering (aOR = 1.28; 95% CI = 1.14-1.44), and dose escalation (aOR = 1.51; 95% CI = 1.34-1.71). Sensitivity analyses showed that mortality outcome is sensitive to variations in cohort selections.

conclusionThe results suggest that any opioid dose change for patients on LTOT may negatively affect all-cause mortality. Clinicians should regularly assess patients on LTOT, considering the benefits and risks of treatment that incorporate evolving evidence on dose changes.

Indexed as

Analgesics, OpioidChronic PainDrug TaperingOpiate OverdoseOpioid-Related DisordersAgedAged, 80 and overCase-Control StudiesFemaleHumansMaleMedicareMortalityUnited StatesAnalgesics, Opioidmortalityolder adultsopioid taperingopioid use disorderoverdose

Identifiers

PMID40261495
PMCPMC12463796

What OpenQuestion holds

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Registered trials

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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.