Opioid Therapy Discontinuation in General Practice: Associations with Adjunct Therapies and Somatoform Pain Disorders

BACKGROUND: Chronic non-cancer pain is a common reason for consultation in primary care. Although opioid therapy may be considered a treatment option for selected patients, guideline-recommended discontinuation can be challenging for both patients and general practitioners. This study investigated predictors of opioid discontinuation in primary care. METHODS: We analyzed German claims data (2021) from patients aged ≥ 18 years with at least one oral or transdermal opioid prescription from general practitioners in the first three quarters of 2021. Exclusion criteria were malignant diseases or palliative care. Opioid discontinuation was operationalized as the absence of an opioid prescription in the fourth quarter. Multivariable logistic regression was used to examine associations between prespecified predictors and the absence of an opioid prescription in the fourth quarter. RESULTS: The cohort included 94,125 patients (mean age 65 years; 62% female). Weak, long-acting opioids were most commonly prescribed. In multivariable regression analyses, adjunct therapy prescriptions were associated with higher odds of the absence of an opioid prescription (OR 1.834), whereas somatoform pain disorders (OR 0.801) and substance use disorders (OR 0.814) were associated with lower odds of the absence of an opioid prescription (all p < 0.001). CONCLUSIONS: These findings are consistent with current guideline recommendations emphasizing the use of adjunct therapies in chronic non-cancer pain management in general practice. Caution is warranted when prescribing opioids to patients with somatoform pain disorders or concurrent substance use disorders. Further research with longer observation periods is needed to confirm these associations and better understand their underlying mechanisms.