{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T06:28:08Z","timestamp":1782368888002,"version":"3.54.5"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Opioid tapering and discontinuation have increased in recent years with the implementation of national prescribing guidelines. This study aimed to examine the relationship between opioid tapering velocity and mental health crisis events in older Medicare beneficiaries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A nested case\u2013control study was conducted using the 2012\u20132018, 5% national Medicare claims data. Older adults with chronic non\u2010cancer pain (CNCP) who were receiving long\u2010term opioid therapy (LTOT) were included in the study. Cases were defined as individuals experiencing mental health crisis events; controls were identified using incidence density sampling. The opioid tapering velocity was measured in the 120\u2010day hazard period that yielded a monthly percentage of dose change. Conditional logistic regression was used to assess the relationship of interest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 42\u2009091 older adults with CNCP were eligible for the study. Cases (<jats:italic>n<\/jats:italic>\u2009=\u2009952) were matched with controls in a 1:2 ratio based on age (\u00b11\u2009year) and time of cohort entry (\u00b130\u2009days). A higher percentage of controls (67.65%) were on steady dose compared with cases (59.03%). In the adjusted model, tapering (aOR\u2009=\u20091.36; 95% CI: 1.02\u20131.83), rapid tapering (aOR\u2009=\u20091.45; 95% CI: 1.11\u20131.91), and dose escalation (aOR\u2009=\u20091.78; 95% CI: 1.32\u20132.39) were significantly associated with the mental health crisis, compared with steady dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Both opioid tapering and dose escalation are associated with mental health crisis events. Patient\u2010driven and gradual dose tapering, as recommended by prescribing guidelines, should be promoted to prevent mental health crisis events among older adults on LTOT.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5698","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T23:24:55Z","timestamp":1695338695000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Opioid tapering and mental health crisis in older adults"],"prefix":"10.1002","volume":"33","author":[{"given":"Shishir","family":"Maharjan","sequence":"first","affiliation":[{"name":"Department of Pharmacy Administration University of Mississippi School of Pharmacy  University Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujith","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration University of Mississippi School of Pharmacy  University Mississippi USA"},{"name":"Center for Pharmaceutical Marketing &amp; Management University of Mississippi School of Pharmacy  University Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaustuv","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration University of Mississippi School of Pharmacy  University Mississippi USA"},{"name":"Center for Pharmaceutical Marketing &amp; Management University of Mississippi School of Pharmacy  University Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Bentley","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration University of Mississippi School of Pharmacy  University Mississippi USA"},{"name":"Center for Pharmaceutical Marketing &amp; Management University of Mississippi School of Pharmacy  University Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ike","family":"Eriator","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, School of Medicine University of Mississippi Medical Center  Jackson Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration University of Mississippi School of Pharmacy  University Mississippi USA"},{"name":"Center for Pharmaceutical Marketing &amp; Management University of Mississippi School of Pharmacy  University Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.18773\/austprescr.2022.002"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6501e1er"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13026"},{"issue":"1","key":"e_1_2_11_5_1","first-page":"31","article-title":"Patterns of long\u2010term prescription opioid use among older adults in the United States: a study of Medicare administrative claims data","volume":"24","author":"Ramachandran S","year":"2021","journal-title":"Pain Physician"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2017.0486"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14\u20102559"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","unstructured":"DowellD RaganK JonesCM BaldwinGT ChouR.CDC Clinical Practice Guideline for Prescribing Opioids for Pain \u2014 United States 2022.2022.; Accessed November 7 2022https:\/\/www.cdc.gov\/mmwr\/volumes\/71\/rr\/rr7103a1.htm","DOI":"10.15585\/mmwr.rr7103a1"},{"key":"e_1_2_11_9_1","volume-title":"Risk of Continued Opioid Use","author":"National committee for quality assurance","year":"2022"},{"key":"e_1_2_11_10_1","volume-title":"Use of Opioids at High Dosage","author":"National committee for quality assurance","year":"2022"},{"key":"e_1_2_11_11_1","unstructured":"IQVIA\u2122.Institute for human data science study: U.S. prescription opioid volume declined 12 percent in 2017 \u2013 largest drop in 25\u2009years. 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