New Alcohol-related Condition Diagnoses Are Associated With Opioid Tapers Among Patients Receiving Long-term Opioid Therapy

Objectives The study sought to describe the association between alcohol-related conditions (ARCs) and long-term opioid therapy (LTOT) dose trajectories among patients with chronic pain. We explored if ARCs moderated the association between LTOT tapers and mortality. Methods We conducted a retrospective cohort study of 3912 patients receiving LTOT. The association of ARCs before initiating LTOT with subsequent LTOT dose trajectories (increasing, decreasing, stable) was assessed using multinomial regression models. The association of LTOT trajectories with subsequently diagnosed new (incident) ARC was assessed using competing risks regression models. Lastly, we explored whether ARCs moderated the association between LTOT trajectories and all-cause mortality using Cox-proportional hazards models. Results Overall, 6.2% (n = 244) of patients receiving LTOT were diagnosed with an ARC prior to initiating LTOT. There was no association between an ARC prior to LTOT initiation with subsequent LTOT trajectory. Among patients without an ARC diagnosis before initiating LTOT, newly diagnosed ARCs were made in 1.3% (n = 50) of patients. Patients in the decreasing LTOT trajectory were twice as likely to be diagnosed with new ARCs compared to those in the stable LTOT trajectory (adjusted hazard ratio, 2.23 [95% CI, 1.15–4.29]). The presence of ARCs did not significantly moderate the relationship between LTOT trajectories and mortality risk. Conclusions Patients in the decreasing LTOT trajectory are at a higher risk of developing a new ARC. Implementing routine alcohol use screening among patients with LTOT taper would enable early identification for alcohol use. Interventions to reduce alcohol use may mitigate harms associated with LTOT taper.