Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids
Opioid-related mortality and national prescribing guidelines have led to tapering of doses among patients prescribed long-term opioid therapy for chronic pain. There is limited information about risks related to tapering, including overdose and mental health crisis. To assess whether there are assoc...
Saved in:
| Published in: | JAMA : the journal of the American Medical Association Vol. 326; no. 5; p. 411 |
|---|---|
| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
03.08.2021
|
| Subjects: | |
| ISSN: | 1538-3598, 1538-3598 |
| Online Access: | Get more information |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Abstract | Opioid-related mortality and national prescribing guidelines have led to tapering of doses among patients prescribed long-term opioid therapy for chronic pain. There is limited information about risks related to tapering, including overdose and mental health crisis.
To assess whether there are associations between opioid dose tapering and rates of overdose and mental health crisis among patients prescribed stable, long-term, higher-dose opioids.
Retrospective cohort study using deidentified medical and pharmacy claims and enrollment data from the OptumLabs Data Warehouse from 2008 to 2019. Adults in the US prescribed stable higher doses (mean ≥50 morphine milligram equivalents/d) of opioids for a 12-month baseline period with at least 2 months of follow-up were eligible for inclusion.
Opioid tapering, defined as at least 15% relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period. Maximum monthly dose reduction velocity was computed during the same period.
Emergency or hospital encounters for (1) drug overdose or withdrawal and (2) mental health crisis (depression, anxiety, suicide attempt) during up to 12 months of follow-up. Discrete time negative binomial regression models estimated adjusted incidence rate ratios (aIRRs) of outcomes as a function of tapering (vs no tapering) and dose reduction velocity.
The final cohort included 113 618 patients after 203 920 stable baseline periods. Among the patients who underwent dose tapering, 54.3% were women (vs 53.2% among those who did not undergo dose tapering), the mean age was 57.7 years (vs 58.3 years), and 38.8% were commercially insured (vs 41.9%). Posttapering patient periods were associated with an adjusted incidence rate of 9.3 overdose events per 100 person-years compared with 5.5 events per 100 person-years in nontapered periods (adjusted incidence rate difference, 3.8 per 100 person-years [95% CI, 3.0-4.6]; aIRR, 1.68 [95% CI, 1.53-1.85]). Tapering was associated with an adjusted incidence rate of 7.6 mental health crisis events per 100 person-years compared with 3.3 events per 100 person-years among nontapered periods (adjusted incidence rate difference, 4.3 per 100 person-years [95% CI, 3.2-5.3]; aIRR, 2.28 [95% CI, 1.96-2.65]). Increasing maximum monthly dose reduction velocity by 10% was associated with an aIRR of 1.09 for overdose (95% CI, 1.07-1.11) and of 1.18 for mental health crisis (95% CI, 1.14-1.21).
Among patients prescribed stable, long-term, higher-dose opioid therapy, tapering events were significantly associated with increased risk of overdose and mental health crisis. Although these findings raise questions about potential harms of tapering, interpretation is limited by the observational study design. |
|---|---|
| AbstractList | Opioid-related mortality and national prescribing guidelines have led to tapering of doses among patients prescribed long-term opioid therapy for chronic pain. There is limited information about risks related to tapering, including overdose and mental health crisis.
To assess whether there are associations between opioid dose tapering and rates of overdose and mental health crisis among patients prescribed stable, long-term, higher-dose opioids.
Retrospective cohort study using deidentified medical and pharmacy claims and enrollment data from the OptumLabs Data Warehouse from 2008 to 2019. Adults in the US prescribed stable higher doses (mean ≥50 morphine milligram equivalents/d) of opioids for a 12-month baseline period with at least 2 months of follow-up were eligible for inclusion.
Opioid tapering, defined as at least 15% relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period. Maximum monthly dose reduction velocity was computed during the same period.
Emergency or hospital encounters for (1) drug overdose or withdrawal and (2) mental health crisis (depression, anxiety, suicide attempt) during up to 12 months of follow-up. Discrete time negative binomial regression models estimated adjusted incidence rate ratios (aIRRs) of outcomes as a function of tapering (vs no tapering) and dose reduction velocity.
The final cohort included 113 618 patients after 203 920 stable baseline periods. Among the patients who underwent dose tapering, 54.3% were women (vs 53.2% among those who did not undergo dose tapering), the mean age was 57.7 years (vs 58.3 years), and 38.8% were commercially insured (vs 41.9%). Posttapering patient periods were associated with an adjusted incidence rate of 9.3 overdose events per 100 person-years compared with 5.5 events per 100 person-years in nontapered periods (adjusted incidence rate difference, 3.8 per 100 person-years [95% CI, 3.0-4.6]; aIRR, 1.68 [95% CI, 1.53-1.85]). Tapering was associated with an adjusted incidence rate of 7.6 mental health crisis events per 100 person-years compared with 3.3 events per 100 person-years among nontapered periods (adjusted incidence rate difference, 4.3 per 100 person-years [95% CI, 3.2-5.3]; aIRR, 2.28 [95% CI, 1.96-2.65]). Increasing maximum monthly dose reduction velocity by 10% was associated with an aIRR of 1.09 for overdose (95% CI, 1.07-1.11) and of 1.18 for mental health crisis (95% CI, 1.14-1.21).
Among patients prescribed stable, long-term, higher-dose opioid therapy, tapering events were significantly associated with increased risk of overdose and mental health crisis. Although these findings raise questions about potential harms of tapering, interpretation is limited by the observational study design. Opioid-related mortality and national prescribing guidelines have led to tapering of doses among patients prescribed long-term opioid therapy for chronic pain. There is limited information about risks related to tapering, including overdose and mental health crisis.ImportanceOpioid-related mortality and national prescribing guidelines have led to tapering of doses among patients prescribed long-term opioid therapy for chronic pain. There is limited information about risks related to tapering, including overdose and mental health crisis.To assess whether there are associations between opioid dose tapering and rates of overdose and mental health crisis among patients prescribed stable, long-term, higher-dose opioids.ObjectiveTo assess whether there are associations between opioid dose tapering and rates of overdose and mental health crisis among patients prescribed stable, long-term, higher-dose opioids.Retrospective cohort study using deidentified medical and pharmacy claims and enrollment data from the OptumLabs Data Warehouse from 2008 to 2019. Adults in the US prescribed stable higher doses (mean ≥50 morphine milligram equivalents/d) of opioids for a 12-month baseline period with at least 2 months of follow-up were eligible for inclusion.Design, Setting, and ParticipantsRetrospective cohort study using deidentified medical and pharmacy claims and enrollment data from the OptumLabs Data Warehouse from 2008 to 2019. Adults in the US prescribed stable higher doses (mean ≥50 morphine milligram equivalents/d) of opioids for a 12-month baseline period with at least 2 months of follow-up were eligible for inclusion.Opioid tapering, defined as at least 15% relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period. Maximum monthly dose reduction velocity was computed during the same period.ExposuresOpioid tapering, defined as at least 15% relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period. Maximum monthly dose reduction velocity was computed during the same period.Emergency or hospital encounters for (1) drug overdose or withdrawal and (2) mental health crisis (depression, anxiety, suicide attempt) during up to 12 months of follow-up. Discrete time negative binomial regression models estimated adjusted incidence rate ratios (aIRRs) of outcomes as a function of tapering (vs no tapering) and dose reduction velocity.Main Outcomes and MeasuresEmergency or hospital encounters for (1) drug overdose or withdrawal and (2) mental health crisis (depression, anxiety, suicide attempt) during up to 12 months of follow-up. Discrete time negative binomial regression models estimated adjusted incidence rate ratios (aIRRs) of outcomes as a function of tapering (vs no tapering) and dose reduction velocity.The final cohort included 113 618 patients after 203 920 stable baseline periods. Among the patients who underwent dose tapering, 54.3% were women (vs 53.2% among those who did not undergo dose tapering), the mean age was 57.7 years (vs 58.3 years), and 38.8% were commercially insured (vs 41.9%). Posttapering patient periods were associated with an adjusted incidence rate of 9.3 overdose events per 100 person-years compared with 5.5 events per 100 person-years in nontapered periods (adjusted incidence rate difference, 3.8 per 100 person-years [95% CI, 3.0-4.6]; aIRR, 1.68 [95% CI, 1.53-1.85]). Tapering was associated with an adjusted incidence rate of 7.6 mental health crisis events per 100 person-years compared with 3.3 events per 100 person-years among nontapered periods (adjusted incidence rate difference, 4.3 per 100 person-years [95% CI, 3.2-5.3]; aIRR, 2.28 [95% CI, 1.96-2.65]). Increasing maximum monthly dose reduction velocity by 10% was associated with an aIRR of 1.09 for overdose (95% CI, 1.07-1.11) and of 1.18 for mental health crisis (95% CI, 1.14-1.21).ResultsThe final cohort included 113 618 patients after 203 920 stable baseline periods. Among the patients who underwent dose tapering, 54.3% were women (vs 53.2% among those who did not undergo dose tapering), the mean age was 57.7 years (vs 58.3 years), and 38.8% were commercially insured (vs 41.9%). Posttapering patient periods were associated with an adjusted incidence rate of 9.3 overdose events per 100 person-years compared with 5.5 events per 100 person-years in nontapered periods (adjusted incidence rate difference, 3.8 per 100 person-years [95% CI, 3.0-4.6]; aIRR, 1.68 [95% CI, 1.53-1.85]). Tapering was associated with an adjusted incidence rate of 7.6 mental health crisis events per 100 person-years compared with 3.3 events per 100 person-years among nontapered periods (adjusted incidence rate difference, 4.3 per 100 person-years [95% CI, 3.2-5.3]; aIRR, 2.28 [95% CI, 1.96-2.65]). Increasing maximum monthly dose reduction velocity by 10% was associated with an aIRR of 1.09 for overdose (95% CI, 1.07-1.11) and of 1.18 for mental health crisis (95% CI, 1.14-1.21).Among patients prescribed stable, long-term, higher-dose opioid therapy, tapering events were significantly associated with increased risk of overdose and mental health crisis. Although these findings raise questions about potential harms of tapering, interpretation is limited by the observational study design.Conclusions and RelevanceAmong patients prescribed stable, long-term, higher-dose opioid therapy, tapering events were significantly associated with increased risk of overdose and mental health crisis. Although these findings raise questions about potential harms of tapering, interpretation is limited by the observational study design. |
| Author | Xing, Guibo Tancredi, Daniel J Fenton, Joshua J Agnoli, Alicia Jerant, Anthony Magnan, Elizabeth |
| Author_xml | – sequence: 1 givenname: Alicia surname: Agnoli fullname: Agnoli, Alicia organization: Center for Healthcare Policy and Research, University of California, Davis, Sacramento – sequence: 2 givenname: Guibo surname: Xing fullname: Xing, Guibo organization: Center for Healthcare Policy and Research, University of California, Davis, Sacramento – sequence: 3 givenname: Daniel J surname: Tancredi fullname: Tancredi, Daniel J organization: Department of Pediatrics, University of California, Davis, Sacramento – sequence: 4 givenname: Elizabeth surname: Magnan fullname: Magnan, Elizabeth organization: Center for Healthcare Policy and Research, University of California, Davis, Sacramento – sequence: 5 givenname: Anthony surname: Jerant fullname: Jerant, Anthony organization: Center for Healthcare Policy and Research, University of California, Davis, Sacramento – sequence: 6 givenname: Joshua J surname: Fenton fullname: Fenton, Joshua J organization: OptumLabs Visiting Fellow, Eden Prairie, Minnesota |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34342618$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkD1PwzAQhi1URD9gZkMeWVL8mThjVQpFKmqHIsbIiS_gKomDnSLx7zGiSNwNd7rn0TvcFI061wFC15TMKSH07qBbPWeE0TmlhPIzNKGSq4TLXI3-7WM0DeFAYlGeXaAxF1ywlKoJ6hYhuMrqwboOuxrfuwB4r3vwtnvDr3Z4x9tP8Obn7Dx-hm7QDV6DbiJZehtswIvWRXcXMyINeOchVN6WYPAmgmQA3-Jtb5014RKd17oJcHWaM_TysNov18lm-_i0XGwSLQQZEiWEyKSRjPGa1CJXpcqr1AjFs1SWvK60ZLnKFWe0LlleklLXaWxDBBhuCJuh29_c3ruPI4ShaG2ooGl0B-4YCiZlJoXMOY3qzUk9li2Yove21f6r-PsR-wantmrn |
| CitedBy_id | crossref_primary_10_1080_15360288_2022_2149670 crossref_primary_10_1136_bmjqs_2024_017657 crossref_primary_10_1001_jama_2023_6539 crossref_primary_10_2196_40507 crossref_primary_10_1097_01_BACK_0000840676_81870_99 crossref_primary_10_1097_01_NAJ_0000799040_11324_f4 crossref_primary_10_1001_jamainternmed_2024_6683 crossref_primary_10_1080_17581869_2025_2516409 crossref_primary_10_1111_dar_13879 crossref_primary_10_1007_s11606_022_07686_z crossref_primary_10_1016_j_drugalcdep_2021_109108 crossref_primary_10_1016_j_jpain_2023_07_027 crossref_primary_10_1097_j_pain_0000000000002443 crossref_primary_10_1093_aje_kwae394 crossref_primary_10_1016_j_amepre_2025_108085 crossref_primary_10_1212_CON_0000000000001476 crossref_primary_10_1001_jamanetworkopen_2024_38325 crossref_primary_10_3390_pharmacy12040116 crossref_primary_10_1097_j_pain_0000000000003133 crossref_primary_10_1136_bmjopen_2023_073297 crossref_primary_10_1002_jac5_2067 crossref_primary_10_1007_s11606_023_08149_9 crossref_primary_10_1016_j_pmedr_2025_103124 crossref_primary_10_1007_s11606_023_08419_6 crossref_primary_10_1016_j_semradonc_2023_01_002 crossref_primary_10_1097_01_TPM_0000822712_08556_db crossref_primary_10_1136_bmjopen_2022_064457 crossref_primary_10_1016_j_labeco_2023_102358 crossref_primary_10_1001_jama_2021_11118 crossref_primary_10_1016_j_drugalcdep_2021_109232 crossref_primary_10_1111_dar_13885 crossref_primary_10_1093_pm_pnae002 crossref_primary_10_1177_08897077231190697 crossref_primary_10_1093_pm_pnae121 crossref_primary_10_1007_s11606_025_09492_9 crossref_primary_10_1007_s40263_025_01215_2 crossref_primary_10_1111_add_16133 crossref_primary_10_7759_cureus_18892 crossref_primary_10_1080_15360288_2022_2113594 crossref_primary_10_1093_pm_pnae119 crossref_primary_10_5694_mja2_52002 crossref_primary_10_1016_j_jpain_2023_11_019 crossref_primary_10_1177_08897077231198299 crossref_primary_10_1212_CON_0000000000001487 crossref_primary_10_1016_j_amepre_2022_09_013 crossref_primary_10_1097_NHH_0000000000001203 crossref_primary_10_1001_jamanetworkopen_2024_1342 crossref_primary_10_1097_JXX_0000000000000734 crossref_primary_10_3390_jpm14010031 crossref_primary_10_1002_pds_5708 crossref_primary_10_14423_SMJ_0000000000001703 crossref_primary_10_1186_s13722_022_00311_8 crossref_primary_10_2147_JPR_S406034 crossref_primary_10_1097_j_pain_0000000000002746 crossref_primary_10_1177_09637214231162366 crossref_primary_10_3389_fpsyt_2022_820357 crossref_primary_10_1007_s11606_022_07862_1 crossref_primary_10_1080_1061186X_2022_2138895 crossref_primary_10_1097_WNR_0000000000001963 crossref_primary_10_1093_aje_kwae094 crossref_primary_10_1016_j_amjmed_2024_01_022 crossref_primary_10_1097_j_pain_0000000000002982 crossref_primary_10_5694_mja2_52713 crossref_primary_10_1038_s41598_025_15113_6 crossref_primary_10_1002_alz_13489 crossref_primary_10_1016_j_jpain_2024_01_350 crossref_primary_10_1002_14651858_CD016178 crossref_primary_10_1093_ageing_afae047 crossref_primary_10_15585_mmwr_mm7235a3 crossref_primary_10_1007_s11606_023_08528_2 crossref_primary_10_1016_j_dadr_2025_100347 crossref_primary_10_1002_cncr_33961 crossref_primary_10_1080_10410236_2024_2363674 crossref_primary_10_1016_j_focus_2025_100371 crossref_primary_10_1177_08897077231186216 crossref_primary_10_1097_PR9_0000000000001128 crossref_primary_10_1136_bmjopen_2022_067542 crossref_primary_10_1136_bmjqs_2024_017101 crossref_primary_10_1080_09638288_2023_2212916 crossref_primary_10_1111_ajad_13327 crossref_primary_10_1111_add_16110 crossref_primary_10_1016_j_drugpo_2022_103708 crossref_primary_10_1016_j_peptides_2023_171004 crossref_primary_10_2147_JPR_S367753 crossref_primary_10_1097_j_pain_0000000000002453 crossref_primary_10_1007_s11606_025_09712_2 crossref_primary_10_1016_j_drugalcdep_2023_109933 crossref_primary_10_1016_j_drugpo_2024_104600 crossref_primary_10_1136_bmjopen_2021_057174 crossref_primary_10_1093_geroni_igaf028 crossref_primary_10_1111_papr_13440 crossref_primary_10_3390_ph14121279 crossref_primary_10_1371_journal_pone_0269809 crossref_primary_10_1001_jama_2022_0323 crossref_primary_10_18282_po3628 crossref_primary_10_3389_fpsyt_2022_1046648 crossref_primary_10_1371_journal_pmed_1004123 crossref_primary_10_1016_j_drugalcdep_2023_111065 crossref_primary_10_1097_01_NAJ_0000925528_83750_03 crossref_primary_10_1016_j_jpainsymman_2021_10_015 crossref_primary_10_1007_s11606_022_07732_w crossref_primary_10_1016_j_amepre_2024_10_004 crossref_primary_10_1016_j_genhosppsych_2023_11_003 crossref_primary_10_1007_s11606_022_07675_2 crossref_primary_10_1186_s13722_023_00424_8 crossref_primary_10_1001_jama_2023_6454 crossref_primary_10_1016_j_jamda_2025_105522 crossref_primary_10_1080_16066359_2024_2305440 crossref_primary_10_1001_jama_2022_0231 crossref_primary_10_1016_j_drugpo_2023_104119 crossref_primary_10_1097_j_pain_0000000000003179 crossref_primary_10_1136_bmj_2021_066375 crossref_primary_10_1097_ADM_0000000000001412 crossref_primary_10_1002_pds_5443 crossref_primary_10_1007_s11864_022_00985_x crossref_primary_10_1136_rapm_2023_104807 crossref_primary_10_1016_j_cct_2022_106857 crossref_primary_10_1177_17151635231188334 crossref_primary_10_1080_17512433_2024_2318470 crossref_primary_10_1007_s11606_022_07991_7 crossref_primary_10_2147_JPR_S453155 crossref_primary_10_1001_jamanetworkopen_2022_34671 crossref_primary_10_15585_mmwr_rr7103a1 crossref_primary_10_1089_jpm_2023_0251 crossref_primary_10_1371_journal_pone_0266561 crossref_primary_10_1002_jhrm_21585 crossref_primary_10_1111_bcpt_13844 crossref_primary_10_1093_jalm_jfae118 crossref_primary_10_1016_j_jpainsymman_2021_09_014 crossref_primary_10_1097_MD_0000000000034885 crossref_primary_10_1097_j_pain_0000000000002518 crossref_primary_10_1016_j_drugalcdep_2023_110819 crossref_primary_10_3390_jcm13247770 crossref_primary_10_1136_bmjph_2023_000725 crossref_primary_10_1097_j_pain_0000000000002994 crossref_primary_10_1007_s00520_022_07528_y crossref_primary_10_1016_j_jpainsymman_2022_05_001 crossref_primary_10_1001_jamanetworkopen_2024_13698 crossref_primary_10_1007_s40266_024_01154_5 crossref_primary_10_1002_jac5_70002 crossref_primary_10_1371_journal_pdig_0000785 crossref_primary_10_1001_jamanetworkopen_2021_44369 crossref_primary_10_1007_s11606_021_07370_8 crossref_primary_10_1093_pm_pnae051 crossref_primary_10_1016_j_anclin_2023_03_006 crossref_primary_10_1016_j_rcsop_2025_100580 crossref_primary_10_1097_AJP_0000000000001064 crossref_primary_10_1001_jamanetworkopen_2022_16733 crossref_primary_10_1016_j_dhjo_2022_101294 crossref_primary_10_1007_s11606_022_08014_1 crossref_primary_10_1097_j_pain_0000000000003638 crossref_primary_10_1001_jamanetworkopen_2022_55101 crossref_primary_10_1111_bcp_15972 crossref_primary_10_1001_jamanetworkopen_2022_9191 crossref_primary_10_1002_pds_5581 crossref_primary_10_1097_j_pain_0000000000002785 crossref_primary_10_2196_51825 crossref_primary_10_1016_j_drugpo_2022_103888 crossref_primary_10_1136_bmj_2023_076509 crossref_primary_10_1016_j_josat_2024_209341 crossref_primary_10_1007_s11606_022_07876_9 crossref_primary_10_1016_j_jpain_2024_104694 crossref_primary_10_1016_j_jvs_2025_03_189 crossref_primary_10_1177_00912174221114245 crossref_primary_10_1056_NEJMp2115244 crossref_primary_10_1001_jamapediatrics_2021_3849 crossref_primary_10_1016_j_drugalcdep_2024_111277 crossref_primary_10_1001_jamanetworkopen_2022_16726 crossref_primary_10_1002_pmrj_13192 crossref_primary_10_1007_s11606_022_07807_8 crossref_primary_10_1176_appi_ajp_22020102 crossref_primary_10_1007_s10461_022_03671_z crossref_primary_10_1111_add_16679 crossref_primary_10_1016_j_drugalcdep_2022_109392 crossref_primary_10_1007_s11606_021_07269_4 crossref_primary_10_1080_03007995_2022_2148459 crossref_primary_10_1093_jnci_djad241 crossref_primary_10_1097_01_BACK_0000794376_98795_81 crossref_primary_10_1097_01_BACK_0000924384_95445_3e crossref_primary_10_1016_j_jpain_2023_11_002 crossref_primary_10_1001_jamanetworkopen_2022_26523 crossref_primary_10_1080_15360288_2024_2407461 crossref_primary_10_1002_pds_5698 crossref_primary_10_1177_00220426251346673 crossref_primary_10_1007_s11606_023_08459_y crossref_primary_10_1080_17581869_2025_2463865 crossref_primary_10_1002_pds_5699 crossref_primary_10_1080_07853890_2022_2121417 crossref_primary_10_1080_15360288_2023_2288109 |
| ContentType | Journal Article |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1001/jama.2021.11013 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1538-3598 |
| ExternalDocumentID | 34342618 |
| Genre | Research Support, Non-U.S. Gov't Journal Article Observational Study |
| GrantInformation_xml | – fundername: NICHD NIH HHS grantid: K12 HD051958 – fundername: NIAMS NIH HHS grantid: K12 AR084220 |
| GroupedDBID | --- -ET -~X .55 .XZ 0R~ 0WA 186 18M 29J 2CT 2FS 2KS 2WC 354 39C 4.4 53G 5GY 5RE 6TJ 85S AAIKC AAMNW AAQQT AAWTL ABBLC ABCQX ABEHJ ABIVO ABOCM ABPMR ABPPZ ABRSH ABWJO ACGFS ACNCT ACPRK ACQAM ADBBV ADUKH AFCHL AFFNX AFRAH AGFXO AGHSJ AHMBA ALMA_UNASSIGNED_HOLDINGS AMJDE ANMPU BKOMP BRYMA C45 CGR CJ0 CS3 CUY CVF EAM EBD EBS ECM EIF EJD EMOBN EX3 F5P GX1 H13 HF~ KOO KQ8 L7B MVM N4W N9A NEJ NPM NYF OBH OCB OGEVE OHH OK1 OMK OVD P2P PKN PQQKQ RAJ RNS SJN SV3 TEORI TN5 UHB UIG UKR UPT VVN WH7 WOW X7M XHN XSW XZL YCJ YFH YIF YIN YOC YPV YQT YQY YR2 YR5 YSK YYM YZZ ZCA ~H1 7X8 ACAHW ADXHL ARBJA |
| ID | FETCH-LOGICAL-a440t-844475d5223f0f498b89c6d483765b3fca529898321fb29b0baf6f6fd04ed3d02 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 201 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000685297500016&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1538-3598 |
| IngestDate | Wed Oct 01 13:17:33 EDT 2025 Wed Feb 19 02:08:37 EST 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 5 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-a440t-844475d5223f0f498b89c6d483765b3fca529898321fb29b0baf6f6fd04ed3d02 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 |
| OpenAccessLink | https://jamanetwork.com/journals/jama/articlepdf/2782643/jama_agnoli_2021_oi_210076_1644868471.8517.pdf |
| PMID | 34342618 |
| PQID | 2557545931 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2557545931 pubmed_primary_34342618 |
| PublicationCentury | 2000 |
| PublicationDate | 2021-08-03 20210803 |
| PublicationDateYYYYMMDD | 2021-08-03 |
| PublicationDate_xml | – month: 08 year: 2021 text: 2021-08-03 day: 03 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | JAMA : the journal of the American Medical Association |
| PublicationTitleAlternate | JAMA |
| PublicationYear | 2021 |
| References | 34342635 - JAMA. 2021 Aug 3;326(5):388-389 35166820 - JAMA. 2022 Feb 15;327(7):687 35166798 - JAMA. 2022 Feb 15;327(7):688 34537097 - Lancet Psychiatry. 2021 Oct;8(10):863 34978849 - Ann Intern Med. 2022 Jan;175(1):JC11 35166803 - JAMA. 2022 Feb 15;327(7):687 |
| References_xml | – reference: 34978849 - Ann Intern Med. 2022 Jan;175(1):JC11 – reference: 34342635 - JAMA. 2021 Aug 3;326(5):388-389 – reference: 35166798 - JAMA. 2022 Feb 15;327(7):688 – reference: 35166820 - JAMA. 2022 Feb 15;327(7):687 – reference: 35166803 - JAMA. 2022 Feb 15;327(7):687 – reference: 34537097 - Lancet Psychiatry. 2021 Oct;8(10):863 |
| SSID | ssj0000137 |
| Score | 2.684933 |
| Snippet | Opioid-related mortality and national prescribing guidelines have led to tapering of doses among patients prescribed long-term opioid therapy for chronic pain.... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 411 |
| SubjectTerms | Adult Aged Analgesics, Opioid - administration & dosage Analgesics, Opioid - adverse effects Chronic Pain - drug therapy Drug Overdose - epidemiology Drug Tapering - psychology Female Humans Male Mental Health Middle Aged Retrospective Studies Substance Withdrawal Syndrome - etiology Young Adult |
| Title | Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/34342618 https://www.proquest.com/docview/2557545931 |
| Volume | 326 |
| WOSCitedRecordID | wos000685297500016&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1JS8NAFB7UinhxX-rGCF6DSWbazJxEqsWDXQ4VeyuzYi5JbKq_3_eSlPYiCBLIISEQ5m1f5r18HyF3UQJlPzI-cAzCjUcyCTT4USC5llaaMDZeVGITyXAoplM5bjbcymascpkTq0Rtc4N75PcAfROo9pJFD8VngKpR2F1tJDQ2SYsBlEGvTqZijT6q4sysghqZ6pbUPivWoTjCOXjUNvgNX1Z1pr__3zc8IHsNwqSPtUsckg2XHZGdQdNDPybZmkVo7ulTXjo6UUXFSUjf08UHHYF_W7ycz2lN8kPr35VoD3JCWtJHlCii45qTtaQ4xwHZRztLX-FGgOmejoo0T215Qt76z5PeS9CoLgSK83ARCI4cgBZwGfOh51JoIU3XIvN8t6OZN6qDrO2ocOR1LHWole_CYUPuLLNhfEq2sjxz54QqQBsuVokRTnBlupprr5lUYAFtBVNtcrtcyRl4NbYqVObyr3K2Wss2OavNMStq-o0Z4wy_-8TFH56-JLto5Gpij12RloeYdtdk23wv0nJ-U7kLnIfjwQ9w5cny |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Association+of+Dose+Tapering+With+Overdose+or+Mental+Health+Crisis+Among+Patients+Prescribed+Long-term+Opioids&rft.jtitle=JAMA+%3A+the+journal+of+the+American+Medical+Association&rft.au=Agnoli%2C+Alicia&rft.au=Xing%2C+Guibo&rft.au=Tancredi%2C+Daniel+J&rft.au=Magnan%2C+Elizabeth&rft.date=2021-08-03&rft.eissn=1538-3598&rft.volume=326&rft.issue=5&rft.spage=411&rft_id=info:doi/10.1001%2Fjama.2021.11013&rft_id=info%3Apmid%2F34342618&rft_id=info%3Apmid%2F34342618&rft.externalDocID=34342618 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1538-3598&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1538-3598&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1538-3598&client=summon |