Publication date: Jul 07, 2026
Evidence is needed on tapering long-term prescription opioids in outpatient settings. To determine and compare the effectiveness of 3 opioid tapering and pain control strategies (July 2018 to November 2023). Randomized controlled trial. (ClinicalTrials. gov: NCT03445988). 11 U. S. sites. Adults with pain for at least 6 months receiving a morphine equivalent daily dose (MEDD) of 10 or higher for at least 3 months without moderate or severe opioid use disorder. Patient-centered opioid tapering with close monitoring and electronic supports was administered as taper only, taper plus cognitive behavioral therapy for chronic pain (pain-CBT), or taper plus a chronic pain self-management program (CPSMP). Taper success (primary outcome) was either an MEDD decrease of at least 50% with no increased pain or no MEDD increase with decreased pain intensity. A total of 562 participants were randomly assigned (191 taper only, 203 taper plus pain-CBT, 168 taper plus CPSMP). The taper success rate was 50. 9% (95% CI, 42. 9% to 58. 9%) for taper only, 48. 6% (CI, 41. 0% to 56. 2%) for taper plus pain-CBT, and 44. 5% (CI, 36. 0% to 53. 3%) for taper plus CPSMP. Tapering with pain-CBT or CPSMP provided no benefit in taper success over taper only (taper plus pain-CBT vs. taper only, -2. 4 percentage points [CI, -11. 9 to 7. 2 percentage points]; taper plus CPSMP vs. taper only, -5. 2 percentage points [CI, -15. 3 to 4. 8 percentage points]). Study-related adverse event risk (including opioid withdrawal symptoms) was highest in the taper only group (126 of 191 [66%]) compared with taper plus pain-CBT (109 of 203 [54%]) and taper plus CPSMP (108 of 168 [64%]). Challenges related to COVID-19 reduced the sample size and made treatment groups imbalanced; low behavioral treatment attendance and losses to follow-up could have limited effectiveness. Adding CBT or self-management to patient-centered opioid tapering did not improve taper success at 12 months, although CBT may reduce adverse effects (including opioid withdrawal symptoms). Patient-Centered Outcomes Research Institute.
| Concepts | Keywords |
|---|---|
| July | Cbt |
| Nct03445988 | Centered |
| Opioids | Ci |
| Outpatient | Cpsmp |
| Medd | |
| Months | |
| Opioid | |
| Pain | |
| Patient | |
| Percentage | |
| Points | |
| Prescription | |
| Success | |
| Taper | |
| Tapering |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | pain |
| drug | DRUGBANK | Morphine |
| disease | MESH | opioid use disorder |
| disease | MESH | chronic pain |
| disease | MESH | CBT |
| drug | DRUGBANK | Spinosad |
| disease | MESH | withdrawal symptoms |
| disease | MESH | COVID-19 |