DRUG TREATMENT  -   Tapering Opioids

Communication and trust is essential with SLOW TAPER 
  • Slow taper will prevent frank withdrawal and give time to equilibrate at each level.
  • Share control around logistics of taper.
Educate - Reassure
  • Explain signs of withdrawal pain will likely increase due to withdrawal.
  • Focus on patient strengths & encourage counseling and other therapies for coping with pain.
Protocols for Tapering
  • The goal is to minimize adverse/withdrawal effects.
  • For rapid detoxification literature indicates that a patient needs 20% of the previous day’s dose to prevent withdrawal symptoms.
  • Decisions regarding tapering schedule should be made on an individual basis. Sometimes faster or slower tapering may be warranted.
  • Some experts suggest that the longer the person has been on opioids, the slower the taper should be.
  • Remain engaged with the patient through the tapering process, and provide psychosocial support as needed.
  • Consider using adjuvant agents, such as antidepressants to manage irritability, sleep disturbance, or anti-epileptics for neuropathic pain. 
  • Do not treat withdrawal symptoms with opioids or benzodiazepines after discontinuing opioids.
The Veterans Health Administration tapering tool is a very helpful guide.
Health and Human Services release a very reasonable and compassionate guide on how to go about opioid dose reduction or discontinuation (9/2019).
Other Things to Consider:
  • Depending how long the patient has been on opioids, the patient may have developed a more complex problem that will require a more deliberate and careful approach to opioid tapering. 
  • A syndrome of COMPLEX PERSISTENT OPIOID DEPENDENCE (CPOD) has been nicely described in the journal reference link below.  Furthermore, a clinical approach to this phenomenon has also been described in the other link below.