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We constructed a multivariable Cox proportional hazards model that accounted for time-varying prescription-, prescriber-, and pharmacy-level factors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Participants<\/jats:title>\n                <jats:p>All patients prescribed an opioid analgesic in California from March to December, 2013 (5,326,392 patients).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Main Measures<\/jats:title>\n                <jats:p>Dependent variable: fatal drug overdose involving opioids. Primary independent variable: a 16-level variable denoting all possible opioid dose trajectories using the following categories for current and 30-day previously prescribed daily dose: 0-29, 30-59, 60-89, or \u226590 milligram morphine equivalents (MME).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Results<\/jats:title>\n                <jats:p>Relative to patients prescribed a stable daily dose of 0-29 MME, large (\u22652 categories) dose increases and having a previous or current dose \u226560 MME per day were associated with significantly greater 15-day overdose risk. Patients whose dose decreased from \u226590 to 0-29 MME per day had significantly greater overdose risk compared to both patients prescribed a stable daily dose of \u226590 MME (aHR 3.56, 95%CI 2.24-5.67) and to patients prescribed a stable daily dose of 0-29 MME (aHR 7.87, 95%CI 5.49-11.28). Patients prescribed benzodiazepines also had significantly greater overdose risk; being prescribed Z-drugs, carisoprodol, or psychostimulants was not associated with overdose risk.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Large (\u22652 categories) 30-day dose increases and decreases were both associated with increased risk of fatal opioid overdose, particularly for patients taking \u226590 MME whose opioids were abruptly stopped. Results align with 2022 CDC guidelines that urge caution when reducing opioid doses for patients taking long-term opioid for chronic pain.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11606-023-08419-6","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T20:17:05Z","timestamp":1696450625000},"page":"393-402","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of 30-day prescribed opioid dose trajectory on fatal overdose risk: A population-based, statewide cohort study"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5643-0881","authenticated-orcid":false,"given":"Stephen G.","family":"Henry","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-You","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Crawford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garen J.","family":"Wintemute","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iraklis Erik","family":"Tseregounis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Gasper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Shev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail R.","family":"Cartus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon D.L.","family":"Marshall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Tancredi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Cerd\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,4]]},"reference":[{"issue":"2","key":"8419_CR1","doi-asserted-by":"publisher","first-page":"85","DOI":"10.7326\/0003-4819-152-2-201001190-00006","volume":"152","author":"KM Dunn","year":"2010","unstructured":"Dunn KM, Saunders KW, Rutter CM, et al. 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