• Ishrat Z Alam, Bethany L DiPrete, Brian W Pence, Arrianna Marie Planey, Stephen W Marshall, Naoko Fulcher, and Shabbar I Ranapurwala.
• Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill.
• Pain Med. 2024 Nov 19.

ObjectiveRapid opioid reduction or discontinuation among high-dose long-term opioid therapy patients (HD-LTOT) is associated with increased risk of heroin use, overdose, opioid use disorder, and mental health crises. We examined the association of residential segregation and healthcare access with rapid opioid reduction or discontinuation among HD-LTOT patients, and examined effect measure modification of individual-level characteristics.MethodsUsing 2006-2018 North Carolina private insurance claims data, we conducted a retrospective cohort study of 18-64 years old HD-LTOT patients (≥ 90 morphine milligram equivalents for 81/90 consecutive days), with one-year follow-up. The outcome was rapid opioid reduction or discontinuation (versus maintenance, increase, or gradual reduction/discontinuation). Individual-level characteristics included age, sex, and clinical diagnoses (post-traumatic stress disorder (PTSD), depression, anxiety, and substance use disorder). Neighborhood-level characteristics included healthcare access (measured as geographic distance to healthcare facilities) and residential segregation (operationalized using the Index of Concentration at the Extremes). We conducted bivariate linear regression to estimate one-year risk differences (RDs) and 95% confidence intervals (CIs).ResultsOf 13,375 HD-LTOT patients, 48.6% experienced rapid opioid reduction or discontinuation during one-year follow-up. Female patients and those diagnosed with PTSD who live in areas of least racial and economic privilege have higher risks of rapid opioid reduction or discontinuation compared to those living in areas with the most racial and economic privilege.ConclusionHealthcare providers need to address potential biases towards patients living in underserved and marginalized communities and intersectionality with mental health stigma by prioritizing training and education in delivering unbiased care during opioid tapering.© The Author(s) 2024. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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