Guidance on Opioid Tapering

Guidance on Opioid Tapering Posted By:
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Within the United States, pain is the most common reason for adults to seek medical care within both outpatient and inpatient settings. Chronic pain, characterized as ongoing pain for 3 months or longer with limitations on function, affects 1 in 5 US adults. Although first-line treatments for acute and chronic pain include multimodal and opioid-sparing regimens, opioid medications still are commonly prescribed. For various reasons, a patient and healthcare professional (HCP) may decide to reduce or discontinue opioid medications; one of the major challenges here is continuing to effectively manage pain while concomitantly reducing chronic opioid medications (ie, use for >3 months).

Patient Assessment
As HCPs seek to treat pain conditions, risk assessment and safe opioid prescribing are essential for improved patient outcomes. Optimal pain management must include a comprehensive assessment to capture the complex nature of pain and influential biological, psychological, and social factors. Risk assessment tools coupled with a thorough patient history are invaluable to evaluate for misuse or adverse events of chronic opioid use, as well as an opioid taper regimen. Patients prescribed chronic, high-dose opioid medications for pain are at increased risk for multiple adverse events, including overdose. Benefits and risks of opioid therapy should be evaluated by the prescribing HCP and discussed with the patient. Optimally, a shared decision-making plan to implement an opioid taper would be developed while managing pain with nonopioid treatments.

Patient Education
Patient education and preparation are essential in laying the foundation for an opioid taper. Often patients are hesitant to reduce the opioid medication dose for fear of experiencing physical withdrawal and increased pain. HCPs may empower patients by referencing the evidence on improved function, mood, and decreased pain following voluntary reductions in long-term opioid dosages. Once a taper is initiated, ensure that patients understand there is a risk of overdose if previous regimens are resumed. A naloxone prescription and education on its use should be provided to patients when initiating an opioid taper.

Outpatient Patient-Centric Taper
For best outcomes and when warranted based on individual patient circumstances, a gradual opioid taper is preferred in the outpatient setting. Collaboration between the HCP and patient should inform the pace and timing of an opioid taper. This collaboration may support intermittent pauses depending on the patient response and experience. Reductions in opioid dosages should aim to be 10% or less per month to avoid symptoms of withdrawal. At minimum, monthly visits should be conducted with the patient and include multidisciplinary supports such as behavioral health, nursing, social work, integrative medicine, and physical therapy. During these monthly visits and interactions with the patient, ongoing screening for anxiety, depression, and opioid misuse or opioid use disorder should be conducted.


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Filed under: Neurology , Psychiatry , Public Health , Substance Abuse , NPs & PAs

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