OPIOIDTAPERING INFORMATION

OPIOID TAPERING INFORMATION
Tapering the Dose When Discontinuing
The extended-release (ER)/long-acting (LA) opioid dosage should be tapered in physically dependent
patients to maintain patient safety and comfort during the initial phase of discontinuing ER/LA opioid
therapy.[1] A taper can often be achieved in the outpatient setting with minimal withdrawal symptoms
for patients who choose to stop therapy for elective reasons due to adverse effects or lack of efficacy,
and for patients without severe medical or psychiatric comorbidities.
When available, opioid detoxification in a rehabilitation setting (outpatient or inpatient) can be helpful,
especially for patients unable to reduce their opioid dose in a less structured setting or who cannot
tolerate the taper. For patients who are at high risk for aberrant behaviors (parasuicidal acts,
dealing/selling medications, or those with severe impulse control disorders), tapering an opioid in a
primary care setting is not appropriate, and those patients should be referred to an addiction or pain
specialist with expertise dealing with difficult cases. If the dosage is being tapered because of aberrant
behaviors thought to be due to addiction, the patient should be referred for addiction treatment, with
the clinician continuing to follow up to provide support for non-opioid pain management and to
motivate the patient to seek treatment for addiction.
Decisions regarding the tapering schedule should be made on an individual basis. Approaches to
tapering range from a slow 10% dose reduction per week to a more rapid 25% to 50% reduction every
few days. Factors that may influence the rate of reduction include the reason opioid therapy is being
discontinued, including comorbidities, the starting dose, and withdrawal symptoms. Patients with
complicated withdrawal symptoms should be referred to a pain specialist or a center specializing in
withdrawal treatment.
Experts suggest that at high doses (eg, over 200 mg/d of morphine or equivalent), the initial wean can
be more rapid. The rate of dose reduction often must be slowed when relatively low daily doses, such as
60 to 80 mg/d of morphine (or equivalent), are reached. After patients are withdrawn from ER/LA opioid
therapy, they must still be treated for their painful condition as well as for substance use or psychiatric
disorders.
Reference
1. US Food and Drug Administration. Blueprint for Prescriber Education for Extended-Release
and Long-Acting Opioid Analgesics.
http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM277916.pd
f. Accessed December 30, 2014.