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The outcome variables were OD, OUD, and all-cause mortality. Conditional logistic regression was conducted on matched samples to evaluate the associations between opioid tapering and the outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Results<\/jats:title>\n            <jats:p>Among a cohort of 82,295, 1333 cases of OD, 4933 cases of OUD, and 5971 cases of all-cause mortality were identified. In primary analyses, after controlling for all covariates, compared with steady dose, the odds of OD were significantly lower (aOR =\u20090.74; 95% CI =\u20090.55\u20130.99) for rapid tapering and significantly higher (aOR =\u20092.08; 95% CI =\u20091.64\u20132.65) for dose escalation. Compared to steady dose, the odds of OUD were significantly lower (aOR =\u20090.53; 95% CI =\u20090.46\u20130.60) for rapid tapering and significantly higher (aOR =\u20091.60; 95% CI =\u20091.42\u20131.81) for dose escalation. Compared to steady dose, significantly higher odds for all-cause mortality were found among patients undergoing rapid tapering (aOR =\u20091.28; 95% CI =\u20091.14\u20131.44), and dose escalation (aOR =\u20091.51; 95% CI =\u20091.34\u20131.71). Sensitivity analyses showed that mortality outcome is sensitive to variations in cohort selections.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The results suggest that any opioid dose change for patients on LTOT may negatively affect all-cause mortality. Clinicians should regularly assess patients on LTOT, considering the benefits and risks of treatment that incorporate evolving evidence on dose changes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11606-025-09492-9","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T09:33:25Z","timestamp":1745314405000},"page":"2896-2905","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Opioid Tapering and Opioid Overdose, Opioid Use Disorder, and Mortality Among Older Adults: A Nested Case\u2013Control Study"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1575-5257","authenticated-orcid":false,"given":"Yi","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prachi","family":"Prajapati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujith","family":"Ramachandran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaustuv","family":"Bhattacharya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shadi","family":"Bazzazzadehgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shishir","family":"Maharjan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ike","family":"Eriator","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Bentley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"issue":"1","key":"9492_CR1","first-page":"31","volume":"24","author":"S Ramachandran","year":"2021","unstructured":"Ramachandran S, Salkar M, Bentley JP, Eriator I, Yang Y. 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Dr Ramachandran received grants from the AMCP Foundation, Pharmacy Quality Alliance, and Mississippi Division of Medicaid; consulted for Pharmacy Quality Alliance and served as a co-chair of the Quality Measure Expert Panel, Pharmacy Quality Alliance. Dr Bhattacharya received a subcontract from Jackson Heart Study (NIH \u2013 NHLBI); received contracts from the Mississippi State Department of Health and Mississippi Division of Medicaid and served as a member engagement co-chair in the Real World Evidence Special Interest Group at the International Society for Pharmacoeconomics and Outcomes Research. Dr Eriator received support for attending a National Science Foundation meeting. Dr Bentley received a contract from the Mississippi State Department of Health and consulted for Pharmacy Quality Alliance. All other authors report no conflicts of interests for this work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}