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August 3, 2021

Opioid Tapering Practices—Time for Reconsideration?

Author Affiliations
  • 1Clinical Addiction Research and Education Unit at Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
  • 2Department of Internal Medicine, Michigan Medicine, Ann Arbor
  • 3VA Center for Clinical Management Research, Ann Arbor, Michigan
  • 4Department of Anesthesiology, Michigan Medicine, Ann Arbor
JAMA. 2021;326(5):388-389. doi:10.1001/jama.2021.11118

Over the past 10 years, evidence emerged that opioid analgesics, especially at high doses or when combined with sedative hypnotics, are associated with opioid-related harms, including opioid overdose death.1 Studies have also raised questions regarding efficacy; for instance, the SPACE trial found that opioids were not better than nonopioid medications for improving pain-related function among 240 opioid-naive patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain.2 This evidence has guided efforts to promote opioid tapering for patients receiving long-term opioid therapy based on the assumption that removing a treatment without proven benefit and known harms would improve outcomes.

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