For some patients, opioid use no longer serves the purpose of the original intent of taking them. According to the CDC, opioids may actually cause a patient’s pain to get worse (“opioid induced hyperalgesia”). Side effects of opioids may increase to higher doses creating a vicious cycle. When the patient is being assessed, the benefits of tapering off a medication may outweigh the risks of taking it.
Consider tapering to a reduced opioid dosage or tapering and discontinuing opioid therapy when your patient:
requests dosage reduction
does not have clinically meaningful improvement in pain and function (e.g., at least 30% improvement on the 3-item PEG scale)
is on dosages ≥ 50 MME*/day without benefit or opioids are combined with benzodiazepines
shows signs of substance use disorder (e.g. work or family problems related to opioid use, difficulty controlling use)
experiences overdose or other serious adverse event
shows early warning signs for overdose risk such as
confusion, sedation, or slurred speech (https://www.ok.gov/health2/documents/Pocket_Guide_Tapering.pdf )
For physicians
Graded Chronic Pain Scale Review (Journal)- https://drive.google.com/drive/folders/1fWpRTv8Isdj83W0386Iyrh6BXN-Zjsvf
Free Narcan Locations (Lancaster): https://www.lancasterjoiningforces.org
Opioid Tapering Calculator
VIDEO - Central Sensitization and Opioid Tapering
WEBSITE - Overview/Report
WEBSITE - Tapering – Guidance & Tools
ARTICLE - Patient-Centered Prescription Opioid Tapering in Community Outpatients With Chronic Pain
JOURNAL - Rethinking Opioid Dose Tapering, Prescription Opioid Dependence, and Indications for Buprenorphine
JOURNAL - Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions
JOURNAL - Patient-Centered Reduction or Discontinuation of Long-term Opioid Analgesics
The HHS Guide for Clinicians
PDF/PRESENTATION - SAMSHA Opioids for Pain: Understanding and Mitigating the Risks
PDF/PRESENTATION - Tapering Guidance for Opioids: Existing Best Practices and
Evidence Standards
PDF/PRESENTATION - HHS Guide for Clinicians on the Appropriate Dosage Reduction
or Discontinuation of Long-Term Opioid Analgesics
PDF - Pocket Guide: Tapering Opioids
HANDOUT - Essential Clinical Skills for Opioid Prescribers
HANDOUT - Tapering Resource
HANDOUT - Quick Tips for Caring for New Patients on Long-Term Opioid Therapy
BRAVO
For Patients
VIDEO - Patient Stories About Opioid Tapering
PDF - Opioid Tapering- Information for Patients
WEBSITE - Safe opioid storage, tapering, and disposal
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