Opioid tapering

Opioid tapering is the reduction of opioid doses over time. Opioid tapering is typically done in people taking opioids for chronic pain. Tapering may be conducted in medically-supervised inpatient or outpatient settings.

Community-based opioid tapering increased after the 2016 "Center for Disease Control Guideline for Prescribing Opioids in Chronic Pain" was published, and many prescribers and organizations instigated opioid tapering practices in order to reduce opioid prescribing.[1] While the CDC guideline was intended to inform primary care physicians on new prescription initiation, in many cases it was misapplied beyond this narrow scope and used to inform opioid tapering practices among patients taking long-term prescription opioids for chronic pain.

Voluntary patient-centered opioid tapering has shown success with engagement and reduction of moderate and high-dose opioid doses over the course of months.[2] Principles of patient-centered opioid tapering include: patient consent to taper, patient ability to control the pace of the taper, and pause the taper if desired. Recent published national study protocols ascribe to these principles.[3]

Some healthcare providers have expressed concern about negative consequences of rapid forced tapering including suicidality.[4][5] Human Rights Watch has called the negative consequences of forced prescription opioid tapering in chronic pain to be a "human rights issue".[6]

In April 2019, the Federal Drug Administration issued a drug safety communication warning against sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering.[7] In October 2019, U.S. Health and Human Services published the HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics.[8] The document calls for a patient-centered approach, cautions against a blanket assumption that less opioids is always best, and provides an implementation guide for opioid tapering for patients for whom reduction is best.

  1. ^ Dowell, D.; Haegerich, T. M.; Chou, R. (2016). "CDC Guideline for Prescribing Opioids in Chronic Pain". MMWR. Recommendations and Reports. 65 (15): 1624–1645. doi:10.15585/mmwr.rr6501e1er. PMC 6390846. PMID 26977696.
  2. ^ Darnall, Beth D.; Ziadni, Maisa S.; Stieg, Richard L.; Mackey, Ian G.; Kao, Ming-Chih; Flood, Pamela (2018-05-01). "Patient-Centered Prescription Opioid Tapering in Community Outpatients With Chronic Pain". JAMA Internal Medicine. 178 (5): 707–708. doi:10.1001/jamainternmed.2017.8709. ISSN 2168-6106. PMC 5876887. PMID 29459978.
  3. ^ Darnall, Beth D.; Mackey, Sean C.; Lorig, Kate; Kao, Ming-Chih; Mardian, Aram; Stieg, Richard; Porter, Joel; DeBruyne, Korina; Murphy, Jennifer; Perez, Luzmercy; Okvat, Heather (2019). "Comparative Effectiveness of Cognitive Behavioral Therapy for Chronic Pain and Chronic Pain Self-Management within the Context of Voluntary Patient-Centered Prescription Opioid Tapering: The EMPOWER Study Protocol". Pain Medicine. 21 (8): 1523–1531. doi:10.1093/pm/pnz285. PMC 7530567. PMID 31876947.
  4. ^ Darnall, Beth D. (2018). "International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering". Pain Medicine. 20 (3): 429–433. doi:10.1093/pm/pny228. ISSN 1526-2375. PMC 6657573. PMID 30496540.
  5. ^ "FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering". U.S. Food and Drug Administration. 20 December 2019. Retrieved 4 October 2020.
  6. ^ "Not Allowed to Be Compassionate" (PDF).
  7. ^ "FDA safety communication on opioid tapering". FDA. 2019-07-17.
  8. ^ "HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics" (PDF). U.S. Health and Human Services. October 2019.