Department of Research & Evaluation News

After the Centers for Disease Control and Prevention issued opioid prescribing guidelines in 2016, the national opioid dispensing rates steadily declined. However, while reducing opioid prescriptions is critically important, abruptly stopping opioids for pain has been shown to possibly raise the risk of overdose for patients.

Against this backdrop, Kaiser Permanente was among the first health systems to implement a program that included optimizing opioid prescription and tapering monitoring metrics to reduce opioid misuse. This study examined the risk of overdoses within a safer tapering initiative in a health care setting that integrates health care and pharmacy.

“Our study found that among people with long-term high-dose opioid use, those who started to gradually lower their opioid dose within 3 months were less likely to have an overdose within a year than those who didn’t cut back,” said the paper’s senior author Rulin Hechter, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation.

The study was published in July 2025 in AJPM Focus.

Chronic opioid use can be dangerous

This research is important because earlier studies have shown that taking opioids for a long time often doesn’t help people with ongoing pain who don’t have cancer. Instead, long-term use can cause issues like trouble thinking clearly, feeling tired or depressed, as well as a higher chance of overdosing.

Previous studies also have shown that people who took opioids at doses between 50 and 99 morphine milligram equivalents (MME) each day doubled their risk of dying from an overdose compared to those taking less than 20 MME a day, and the risk was up to 9 times higher for those taking 100 MME or more daily. (Morphine milligram equivalents are values that represent the potency of an opioid dose relative to morphine.)

This Kaiser Permanente study included more than 12,000 adults who with a long-term high-dose opioid use — a daily dose of 50 MME or higher — for 6 months or more between 2013 and 2018. All were Kaiser Permanente Southern California members who did not have cancer.

Slow opioid tapering is possible

The study found:

• About 57% of new long-term high-dose opioid users tapered within 3 months.
• The risk for opioid overdose reduced within 12 months following opioids tapering.
• Reducing daily MME by 20% to 40% monthly was associated with decreased overdose rate.

The trend is different at Kaiser Permanente

“While earlier studies suggested there could be an increased risk of overdose right after tapering, our research found that tapering was linked to a lower risk of opioid overdose,” explained the study’s lead author, Hui Zhou, PhD, of the Department of Research & Evaluation. “It’s a different trend than what’s been reported elsewhere.”

We are proud of our study but caution that more studies in different health care environments are needed for further confirmation.”

Other authors include Katherine J. Pak, MS; Fagen Xie, PhD; Deborah S. Ling Grant, PhD; Joanna L. Barreras, PhD, MSW, of the Department of Research & Evaluation; Patricia L. Gray, PharmD, of Clinical Pharmacy Operations, Kaiser Permanente, Riverside, Calif.; Craig K. Chang, MD, and Steven G. Steinberg, MD, of the Southern California Permanente Medical Group. Dr. Hechter and Dr. Zhou also are affiliated with the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif. Dr. Steinberg also is affiliated with the Department of Research & Evaluation.