Electronic Theses and Dissertations

Date of Award


Document Type


Degree Name

M.S. in Pharmaceutical Science

First Advisor

Yi Yang

Second Advisor

Sujith Ramachandran

Third Advisor

Kaustuv Bhattacharya


University of Mississippi

Relational Format



Background: Opioid tapering and discontinuation have been increasing in recent years with the implementation of national prescribing guidelines. The study aimed to examine the relationship between opioid tapering and mental health crisis events in older Medicare beneficiaries.

Methods: A nested case-control study was conducted using the 2012-2018 5% national Medicare claims data. Older adults with chronic noncancer pain (CNCP) who were receiving long-term opioid therapy (LTOT) were included in the study Cases were defined as individuals experiencing mental health crisis events; controls were identified using incidence density sampling. The opioid tapering velocity was measured in the 120-day hazard period that yielded a monthly percentage of dose change. Conditional logistic regression was used to assess the relationship of interest.

Results: A total of 42,091 older adults with CNCP were eligible for the study. 1,136 cases were matched with controls in a 1:2 ratio based on age (±1 year) and time of cohort entry (±30 days). A higher percentage of controls (68.93%) were on steady dose compared with cases (60.04%). In the adjusted model, tapering (aOR = 1.47; 95% CI: 1.13 – 1.90), rapid tapering (aOR = 1.32; 95% CI: 1.04 – 1.67) and dose escalation (aOR = 1.96; 95% CI: 1.53 – 2.53) were significantly associated with the mental health crisis, compared with steady dose.

Conclusion: Both opioid tapering and dose escalation are associated with mental health crisis events. Gradual and slow tapering, as recommended by prescribing guidelines, should be promoted to prevent mental health crisis events among older adults on LTOT.


Pharmacy Administration



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