• Policies varied in their impacts on opioid tapering and discontinuation. • A change in oxycodone coverage was associated with decreased rapid discontinuation. • Prescribing standards temporarily affected rapid discontinuation in the OUD cohort. • The pandemic was associated with increased rapid discontinuation in the OUD cohort. • Caution is needed in implementing opioid policy to avoid unintended consequences. Rapid opioid tapering and discontinuation may increase overdose risk, but the influence of opioid-related policies on tapering and discontinuation are unclear. 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). 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. 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.
Morrow et al. (Sat,) studied this question.