About

Elizabeth M. Magnan, M.D., Ph.D., is an Associate Professor/Associate Professor In Residence at UC Davis Health within the Department of Family and Community Medicine. Her clinical interests focus on working with patients to find the best treatment plans to improve health and wellness, particularly in managing chronic conditions and behavioral health. She specializes in chronic condition management and enjoys collaborating with patients challenged by multiple chronic conditions. Her research primarily aims to improve health outcomes and the patient experience for patients with complicated health needs, including diabetes and multiple chronic conditions. Dr. Magnan's academic background includes a B.S. from the University of Wisconsin, Madison, an M.D. and Ph.D. from the University of Wisconsin School of Medicine and Public Health, and residency training in Family Medicine at Memorial Family Medicine in Houston, TX. Her scholarly work has contributed to understanding patient characteristics during primary care visits, quality of care metrics for patients with obesity and diabetes, and the impact of clinician-patient interactions on patient satisfaction. She has been recognized with several awards and fellowships, including the UC Davis Internal CDA and CTSC K12/KL2 Scholar and NIH Loan Repayment Program awards. Her research interests are centered on improving health outcomes and the patient experience for those with complex health needs.

Research topics

• Internal medicine
• Emergency medicine
• Psychiatry
• Medicine
• Anesthesia
• Family medicine

Selected publications

• Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering

  JAMA Network Open · 2022 · 89 citations

  • Medicine
  • Emergency medicine
  • Anesthesia

  Importance: Patients prescribed long-term opioid therapy are increasingly undergoing dose tapering. Recent studies suggest that tapering is associated with short-term risks of substance misuse, overdose, and mental health crisis, although lower opioid dose could reduce risks of adverse events over the longer term. Objective: To assess the longer-term risks of overdose or mental health crisis associated with opioid dose tapering. Design, Setting, and Participants: This is a cohort study using an exposure-crossover analysis. Data were obtained from the OptumLabs Data Warehouse, which includes deidentified medical and pharmacy claims and enrollment records for commercial insurance and Medicare Advantage enrollees, representing a diverse mixture of ages, races, ethnicities, and geographical regions across the US. Participants were US adults who underwent opioid dose tapering from 2008 to 2017 after a 12-month baseline period of stable daily dosing of 50 morphine milligram equivalents or higher and who had at least 1 month of long-term follow-up during a postinduction period beginning 12 months after taper initiation. Data analysis was performed from October 2021 to April 2022. Exposures: Opioid tapering, defined as 15% or more relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period after the stable baseline period. Main Outcomes and Measures: Emergency or hospital encounters for drug overdose or withdrawal and mental health crisis (depression, anxiety, or suicide attempt). Outcome counts were assessed in pretaper and postinduction periods (from 12 to 24 months after taper initiation). Results: The study included 21 515 tapering events among 19 377 patients with a mean (SD) of 9.1 (2.7) months of postinduction follow-up per event (median [IQR], 10 [8-11] months). Patients had a mean (SD) age of 56.9 (11.2) years, 11 581 (53.8%) were female, and 8217 (38.2%) had commercial insurance (vs Medicare Advantage). In conditional negative binomial regression analyses, adjusted incidence rate ratios for the postinduction period compared with the pretaper period were 1.57 (95% CI, 1.42-1.74) for overdose or withdrawal and 1.52 (95% CI, 1.35-1.71) for mental health crisis. Conclusions and Relevance: These findings suggest that opioid tapering was associated with increased rates of overdose, withdrawal, and mental health crisis extending up to 2 years after taper initiation.

  DOI

• Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids

  JAMA · 2021 · 268 citations

  • Medicine
  • Emergency medicine
  • Anesthesia

  Importance: Opioid-related mortality and national prescribing guidelines have led to tapering of doses among patients prescribed long-term opioid therapy for chronic pain. There is limited information about risks related to tapering, including overdose and mental health crisis. Objective: To assess whether there are associations between opioid dose tapering and rates of overdose and mental health crisis among patients prescribed stable, long-term, higher-dose opioids. Design, Setting, and Participants: Retrospective cohort study using deidentified medical and pharmacy claims and enrollment data from the OptumLabs Data Warehouse from 2008 to 2019. Adults in the US prescribed stable higher doses (mean ≥50 morphine milligram equivalents/d) of opioids for a 12-month baseline period with at least 2 months of follow-up were eligible for inclusion. Exposures: Opioid tapering, defined as at least 15% relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period. Maximum monthly dose reduction velocity was computed during the same period. Main Outcomes and Measures: Emergency or hospital encounters for (1) drug overdose or withdrawal and (2) mental health crisis (depression, anxiety, suicide attempt) during up to 12 months of follow-up. Discrete time negative binomial regression models estimated adjusted incidence rate ratios (aIRRs) of outcomes as a function of tapering (vs no tapering) and dose reduction velocity. Results: The final cohort included 113 618 patients after 203 920 stable baseline periods. Among the patients who underwent dose tapering, 54.3% were women (vs 53.2% among those who did not undergo dose tapering), the mean age was 57.7 years (vs 58.3 years), and 38.8% were commercially insured (vs 41.9%). Posttapering patient periods were associated with an adjusted incidence rate of 9.3 overdose events per 100 person-years compared with 5.5 events per 100 person-years in nontapered periods (adjusted incidence rate difference, 3.8 per 100 person-years [95% CI, 3.0-4.6]; aIRR, 1.68 [95% CI, 1.53-1.85]). Tapering was associated with an adjusted incidence rate of 7.6 mental health crisis events per 100 person-years compared with 3.3 events per 100 person-years among nontapered periods (adjusted incidence rate difference, 4.3 per 100 person-years [95% CI, 3.2-5.3]; aIRR, 2.28 [95% CI, 1.96-2.65]). Increasing maximum monthly dose reduction velocity by 10% was associated with an aIRR of 1.09 for overdose (95% CI, 1.07-1.11) and of 1.18 for mental health crisis (95% CI, 1.14-1.21). Conclusions and Relevance: Among patients prescribed stable, long-term, higher-dose opioid therapy, tapering events were significantly associated with increased risk of overdose and mental health crisis. Although these findings raise questions about potential harms of tapering, interpretation is limited by the observational study design.

  PublisherOA PDFDOI

Frequent coauthors

• Marykate Miller

  Center For Policy Research

  37 shared

• Garen Corbett

  Positive Resource Center

  37 shared

• Jacqueline Miller

  University of California, San Francisco

  36 shared

• Janet M. Coffman

  University of California, San Francisco

  36 shared

• Riti Shimkhada

  36 shared

• Daniel J. Tancredi

  University of California, Davis

  33 shared

• Joshua J. Fenton

  31 shared

• Alicia Agnoli

  University of California, Davis

  28 shared

Labs

• UC Davis Health Department of Family and Community MedicinePI

Awards & honors

• UC Davis Internal CDA and CTSC K12/KL2 Scholar (2015, 2016,…
• NIH Loan Repayment Program Awardee, Clinical Research (2015,…
• Selected to Attend AAMC Early Career Women Professional Deve…
• Annals of Internal Medicine Top Reviewer (2014)
• John J Frey Writing Award for Creative Writing (2012)

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