Opioid Tapering and Discontinuation: 10 Questions
Safe and effective opioid tapering requires careful patient selection and a multimodal approach. Try our 10 questions on current HHS recommendations.
As concerns continue about the over-prescription of opioids, especially for the management of chronic pain, physicians who are worried that these medications may no longer be indicated for certain of their patients are faced with the challenge of whether and how best to terminate their use.A new guideline issued by the Department of Health and Human Services and a recently published study provide guidance on this issue.Before you read both in full, however, try these 10 questions find out what you may already know about recommendations on tapering and discontinuation of opioids used long-term to manage chronic pain. Safe and effective opioid tapering requires careful patient selection and a multimodal approach. Try these 10 questions on current HHS recommendations.
1. According to the HHS guide,1 rapid tapering or sudden discontinuation of opioids in physically dependent patients can result in which of the above?
Answer: E. All of the above. Rapid or sudden tapering of opioids can lead to an increase in pain, thoughts of suicide, and serious psychological distress as well as acute withdrawal symptoms.
2. The guide recommends abrupt opioid dose reduction or discontinuation should be considered only if which of the above pertain?
Answer: C. There are indications of a life-threatening issue such as warning signs of impending overdose.
3. True or False. The HHS guide recommends that all patients taking opioids for chronic pain should have the medications tapered and discontinued.
Answer: B. False. Although the guide notes that for some patients there may be better treatments for chronic pain than opioids, it does not recommend that discontinuation be pursued for all patients taking the drugs for chronic pain.
4. Opioid dose reduction or tapering with the goal of discontinuation should be considered in which of the circumstances above?
Answer: E. All of the above. Dosage reduction or tapering with the goal of discontinuation of opioid therapy should be considered if a patient’s pain has improved, when there is no improvement despite dose escalation, when there is evidence of opioid misuse, or when other medications or comorbidities increase the risk for adverse outcomes.
5. Which of the above is/are HHS Guide-recommended approaches to opioid tapering?
Answer: B. Discuss with a patient the reasons tapering is indicated. HHS recommends a clinician discuss a patient’s perceptions of risks, benefits, & adverse effects of continued opioid therapy, and include patient concerns in taper planning.
6. For a patient who has comorbid mental health problems, eg, depression, anxiety, PTSD, the guide recommends which of the above?
Answer: A. That these comorbid conditions be treated either before or at the same time as opioid tapering. The guide notes that mental health issues can be common in patients with chronic pain, particularly among those with conditions of longstanding.
7. Which of the above is recommended by the HHS guide with regard to the use of nonopioid and non-pharmacologic (ie, behavioral) therapies for pain in patients for whom opioid tapering is being considered?
Answer: B. Integrating these approaches into treatment before or during opioid tapering. The HHS guide recommends integrating nonopioid and behavioral treatments into the therapeutic regimen before and during opioid tapering as alternative methods of pain management.
8. Which of the above approaches to taper rate is recommended by the HHS guide?
Answer: D. All of the foregoing approaches to taper rate are recommended by HHS. It is worth noting, however, that a recent review of studies on opioid tapering found there is limited evidence on the optimal way to taper opioids.2
9. With regard to the role of buprenorphine in tapering and discontinuation of opioids, the HHS guide recommends which of th above?
Answer: B. Buprenorphine can be considered if tapering is indicated but is unsuccessful.
10. True or False. According to a recent literature review,3 studies show that the most common outcome for the majority of patients taking opioids for chronic pain who undergo opioid tapering and discontinuation is worsening of their pain.
Answer: B. False. In fact, research demonstrates that most chronic pain patients who have undergone opioid tapering report improved pain at the completion of the tapering.