Impact of health policies on opioid tapering and discontinuation among patients receiving long-term opioid therapy for chronic noncancer pain

Int J Drug Policy. 2026 Mar 14;151:105231. doi: 10.1016/j.drugpo.2026.105231. Online ahead of print.

ABSTRACT

BACKGROUND: Rapid opioid tapering and discontinuation may increase overdose risk, but the influence of opioid-related policies on tapering and discontinuation are unclear.

METHODS: Using population data from the BC COVID-19 Cohort, we investigated changes in opioid tapering and discontinuation associated with a change in controlled-release oxycodone coverage, the introduction of regulatory opioid prescribing standards, and the COVID-19 pandemic and related policies among patients receiving long-term opioid therapy (LTOT) for chronic noncancer pain in British Columbia (BC), Canada. Analyses were stratified by individuals without opioid use disorder (non-OUD cohort), individuals with opioid use disorder without recent opioid agonist therapy (OUD cohort), and individuals who received opioid agonist therapy in the previous 90 days (OAT cohort).

FINDINGS: In the non-OUD cohort, the oxycodone policy was associated with an 18·1% (95% CI 16·5-19·6) decrease in rapid discontinuation, representing 5·9 fewer individuals per 1000 population who discontinued bi-weekly; prescribing standards were associated with a short-term 10·1% (95% CI 8·5-11·7) decrease in rapid discontinuation; and the pandemic and related policies were associated with a 7·7% (95% CI 6·4-9·0) decrease in rapid discontinuation. The oxycodone policy was associated with decreases in rapid discontinuation in all cohorts. However, prescribing standards were associated with a short-term increase in rapid discontinuation in the OUD cohort, contrary to guidance accompanying the standards that advised tapering slowly when tapering or discontinuing LTOT.

INTERPRETATION: Rapid opioid tapering and discontinuation among individuals receiving LTOT were shaped by opioid-related policies in BC. Caution is needed in implementing opioid-related policy to avoid unintended consequences.

PMID:41833239 | DOI:10.1016/j.drugpo.2026.105231