Clinician Guide for Appropriate Opioid Dosage Reduction or Discontinuation

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

The U.S. Department of Health and Human Services has released a Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics.  This 6-page Guide looks to be a great resource and I encourage you to download it and share with your Medical staff as well as IDT.

“After increasing every year for more than a decade, annual opioid prescriptions in the United States peaked at 255 million in 2012 and then decreased to 191 million in 2017. More judicious opioid analgesic prescribing can benefit individual patients as well as public health when opioid analgesic use is limited to situations where benefits of opioids are likely to outweigh risks.  At the same time opioid analgesic prescribing changes, such as dose escalation, dose reduction or discontinuation of long-term opioid analgesics, have potential to harm or put patients at risk if not made in a thoughtful, deliberative, collaborative, and measured manner.

Coordination across the health care team is critical.  Clinicians have a responsibility to provide or arrange for coordinated management of patients’ pain and opioid-related problems, and they should never abandon patients.

Prescription opioids benefit the patient only when the benefit of using opioids outweighs the risks. But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough case review and discussion with the patient. HHS does not recommend tapering opioids rapidly or discontinuing suddenly due to the significant risks of opioid withdrawal, unless there is a life-threatening issue confronting the individual patient. The HHS guide provides advice to clinicians who are contemplating or initiating a change in opioid dosage.”

The Guide provides this information:

  • Risks of rapid opioid taper
  • Considerations for tapering to a reduced opioid dosage, or tapering and discontinuing opioid therapy
  • Important considerations prior to deciding to taper
  • Important steps prior to initiating a taper
  • Sharing decision-making with patients
  • Individualizing the taper rate, i.e. slower vs. faster tapers
  • Opioid Tapering Flowchart
  • DSM-5 Opioid Use Disorder
  • Treating symptoms of opioid withdrawal
  • Providing behavioral health support
  • Special populations
  • References