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Center for Evidence-Based Review, excerpt from HERC meeting materials:

HERC’s Value based benafits subcommittee Meeting materials/ public link: https://www.oregon.gov/oha/HPA/DSI-
HERC/MeetingDocuments/VbBS-Materials-1-17-2019.pdf
On page 64
Center for Evidence-based Policy Opioid Tapering Report
 Overall level of evidence very low
 Findings suggested that pain, function, and quality of life might improve during and after opioid discontinuation or
dose reduction
 Scant evidence on harms associated with tapering strategies
– 1 study noted increase in suicidal ideation, some increase in suicidal behavior in a population tapered due to
aberrant behaviors
– Withdrawal symptoms reported
 Reason for discontinuation (patient-initiated vs. clinician- initiated) was not correlated with pain score trajectory
Center for Evidence based policy link: https://centerforevidencebasedpolicy.org

Evidence on Opioid Tapering The following is a summary of the MED 2018 Evidence Review for opioid
tapering as completed by Oregon Health & Science University’s Center for Evidence-based Policy: 1)
Overall quality of the evidence is very low 2) Findings suggested that pain, function, and quality of life
might improve during and after opioid discontinuation or dose reduction 3) Scant evidence on harms
associated with tapering strategies a. Adverse events—mortality, suicide or overdose i. 5 studies in
the Frank review included adverse events 1. 1 opioid-related overdose death in a patient in a
buprenorphine treatment program (after discontinuation of buprenorphine) out of a total of 5 studies
(no N given) ii. A retrospective cohort study conducted in a VA population whose opioid therapy was
discontinued by their clinician (primarily for aberrant behaviors) reported that 12% of the cohort had
documented suicidal ideation and nonfatal suicidal self-directed violence (SSV) in the 12 months after
opioid discontinuation 1. This study identified Hispanic ethnicity (adjusted odds ratio [OR] 7.25 (95% CI
1.96–27.18), PTSD diagnosis: 2.56 (1.23–5.32), and psychoticspectrum disorder diagnoses (OR 3.19; 95%
CI 1.14 to 8.89) were correlated with suicidal ideation and SSV in the 12 months following clinician-
initiated opioid discontinuation. iii. Other new studies did not report information on serious adverse
events such as mortality, suicide, or overdose events. b. Adverse events—opioid withdrawal symptoms
Reprioritization of Certain Chronic Pain Conditions March 2019 14 i. In the systematic review by Frank et
al., 18 studies (3 fair and 15 poor methodological quality) reported opioid withdrawal symptoms. Rates
of withdrawal symptoms ranged widely across the studies (0% to 100%). 4) Taper length a. Not able to
draw any conclusions regarding rapid versus slow tapering. 5) Patient-initiated vs nonpatient-initiated
tapering a. Very little information found on this issue. In almost all of the studies included in the
previous MED report and in this update, patients had some autonomy in the decision to taper their
opioids.