The Department of Health and Human Services (HHS) published a new guide for clinicians on appropriate dosage reduction or discontinuation of long-term opioid analgesics.
This guide recommends reviewing the risks and benefits of current opioid therapy with patients, tailoring tapering or discontinuation plans to specific diagnoses, circumstances, and unique patient needs, while also coordinating with a patient’s other treating physicians.
HHS advises against rapid tapering or discontinuation, as this can cause withdrawal, exacerbation of pain, psychological distress, and thoughts of suicide. Guidelines advise clinicians to consider tapering to a reduced opioid dosage, or tapering and discontinuing opioid therapy, in the following situations:
- Improvement in the underlying pain condition
- Patients request dosage reductions or discontinuation
- Pain and function are not meaningfully improved during opioid therapy
- Patients receive higher opioid doses without evidence of any potential benefit from the higher dose
- Patients demonstrate current evidence of opioid misuse
- Opioid side effects diminish quality of life or impair function
- Patients experience overdose or have warning signs of potential overdose
- Patients are taking other medications or have other medical conditions that increase the odds of adverse outcomes
Furthermore, the guide suggests integrating behavioral therapies into tapering strategies to help manage pain, as failure to manage comorbid mental health disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) can increase the odds of adverse opioid events. This can include offering or arranging for a consultation with a behavioral health provider prior to initiating a taper.
Key to the guidelines is the practice of making shared decisions with patients, working together to individualize the taper rate and collaborate on a plan to manage pain while shifting away from opioids. This includes discussing the various options available to them, including non-opioid pain medications, treatment for opioid-use disorder, strategies to avoid withdrawal, and more.
Healthesystems has previously reported on opioid tapering strategies in RxInformer clinical journal, including similar information reported in the HHS guidelines, along with information on withdrawal symptoms, comorbidities, adjunctive therapies, comprehensive pain management centers, and more.