Table 2. Primary and Secondary Outcomes in a Study of the Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioidsa.
| Outcome | Taperedb | Not taperedb | Adjusted incidence rate difference per 100 person-years by tapering status (95% CI)d,e | Adjusted incidence rate ratio (95% CI)d | P valuec | ||
|---|---|---|---|---|---|---|---|
| No. of events/total person-years | Adjusted incidence rate per 100 person-years (95% CI)d | No. of events/total person-years | Adjusted incidence rate per 100 person-years (95% CI)d | ||||
| Overdosef | |||||||
| Entire cohort | 3241/22 097 | 9.3 (8.5-10.1) | 11 433/152 194 | 5.5 (5.3-5.8) | 3.8 (3.0-4.6) | 1.68 (1.53-1.85) | <.001 |
| Baseline opioid dose, MME/dg | .008 | ||||||
| 50-89 | 530/5321 | 6.6 (5.3-7.9) | 3277/53 260 | 4.6 (4.2-5.0) | 2.0 (0.3-3.3) | 1.43 (1.15-1.77) | |
| 90-149 | 676/5524 | 7.7 (6.4-9.1) | 2607/38 994 | 5.1 (4.6-5.5) | 2.6 (1.2-4.1) | 1.67 (1.34-2.00) | |
| 150-299 | 1047/6864 | 10.9 (9.2-12.7) | 3462/38 782 | 6.5 (6.0-7.0) | 4.4 (2.6-6.2) | 2.36 (1.93-2.79) | |
| ≥300 | 988/4388 | 16.2 (13.9-18.4) | 2087/21 159 | 7.4 (6.6-8.2) | 8.8 (6.4-11.1) | 3.51 (2.94-4.09) | |
| Mental health crisisi | |||||||
| Entire cohort | 3117/22 097 | 7.6 (6.5-8.6) | 8258/152 194 | 3.3 (3.0-3.6) | 4.3 (3.2-5.3) | 2.28 (1.96-2.65) | <.001 |
| Baseline opioid dose, MME/dg | .003 | ||||||
| 50-89 | 525/5321 | 5.2 (3.8-6.5) | 2801/53 260 | 3.4 (3.0-3.9 | 1.8 (0.4-3.2) | 1.51 (1.14-2.01) | |
| 90-149 | 615/5524 | 5.8 (4.3-7.4) | 2045/38 994 | 3.2 (2.7-3.7) | 2.6 (1.0-4.2) | 1.70 (1.21-2.19) | |
| 150-299 | 1080/6864 | 8.7(6.6-10.9) | 2051/38 782 | 3.0 (26-3.5) | 5.7 (3.5-7.8) | 2.54 (1.84-3.24) | |
| ≥300 | 897/4388 | 11.9 (8.8-15.0) | 1361/21 159 | 3.8 (3.0-4.7) | 8.1 (4.9-11.3) | 3.47 (2.45-4.49) | |
| Secondary mental health end pointsh | |||||||
| Depression | 2485/22 097 | 5.5 (4.6-6.4) | 6174/152 194 | 2.2 (2.0-5) | 3.3 (2.4-4.2) | 2.46 (2.05-2.96) | <.001 |
| Anxiety | 505/22 097 | 1.4 (12-1.7) | 1737/152 194 | 0.8 (0.7-0.9) | 0.6 (0.4-0.9) | 1.79 (1.48-2.15) | <.001 |
| Suicide attempt | 127/22 097 | 0.4 (0.2-0.5) | 347/152 194 | 0.1 (0.08-0.13) | 0.3 (0.1-0.4) | 3.30 (2.19-4.98) | <.001 |
A total of 113 618 patients were observed for 174 291 person-years.
Tapering status at the time of an event was defined as tapered for all months after the first of 6 overlapping 60-day period in which a person’s mean daily opioid dose decreased by 15% or more from their baseline period and nontapered for all other periods.
P value refers to the adjusted incidence rate ratio in the whole cohort and the χ2 for the likelihood ratio test for the interaction by baseline dose.
Analyses adjusted for age; sex; education status; rurality of home address; insurance status; comorbidities; baseline opioid dose; co-prescription for benzodiazepines; number of overdose events in the baseline period; baseline depression, anxiety, or suicide attempt; and study year.
Adjusted rate differences and 95% CIs are within-row group rate differences by tapering status.
Overdose refers to the composite outcome for emergency department visits or hospital admissions for drug overdose or withdrawal.
Baseline dose is the average daily opioid dose, in morphine milliequivalents (MME), across the 12-month stable baseline period.
Secondary end points were specified for each of the 3 components.
Mental health crisis refers to the composite outcome for emergency department visits or hospital admissions for depression, anxiety, or suicide attempt.