Module C (subsection 3b):  Maintaining, Tapering, Discontinuing, or Switching from Full Agonist Opioids
CONTINUED...

  • Follow-up as clinically indicated after each change in dosage and after discontinuation, considering patient and treatment characteristics
  • Consider the following at each interaction with patient:
    • Educate on self-management and risks of opioids (see Sidebar K)
    • ​Optimize whole person approach to pain care
    • Reassess for OUD and readiness for OUD treatment as indicated
  • If continuing treatment with opioids, use the following approach:
    • Shortest duration
    • Use lowest effective dose (recognizing that no dose is completely safe and overdose risk increases at doses >20-50 mg MEDD (see Sidebar L)
    • Continual assessment of improvement in pain and functional status and adverse effects.
Are one of the following present?
  • Patient resistance to taper
  • High risk or dangerous behaviors (including elevated risk of suicide)
  • Increase in patient distress
Are one of the following present?
  • Patient resistance to taper
  • High risk or dangerous behaviors (including elevated risk of suicide)
  • Increase in patient distress