Factors Associated with Opioid Tapering Success: A mixed methods study

ABSTRACT Background Opioid tapering is recommended when risks of chronic opioid use outweigh benefits. Little is known about patient characteristics or factors related to tapering success. Objective To identify characteristics that predict a 50% reduction in opioid use and qualitatively characterize factors that impact tapering success. Methods We used multilevel hierarchical modeling to identify predictors of a 50% reduction in opioid use among Kaiser Permanente Northwest patients who underwent pharmacist-led tapering between 2012 and 2017. We conducted qualitative interviews among patients and pharmacists to identify factors impacting tapering success. Results We identified 1,384 patients who, on average, were dispensed 207 milligram morphine equivalents per day (MMED) at baseline. After 12 months, 56% of patients reduced their opioid use by 50%. Increased odds of 50% reduction were associated with younger age 21-49 years (OR: 1.32, p=0.004), prior surgery (OR: 2.24, p Conclusions Over one-half of patients who underwent tapering reduced their opioid use by 50%. Patient demographic and clinical characteristics were predictive of tapering success; however, patients and pharmacists noted that patient willingness, motivation, and personal circumstances also impact tapering outcome. Opioid tapering requires an individualized approach. Both clinical factors and personal circumstances should be considered when opioid tapering is being discussed as a possible solution for a patient.