Nonpharmacological and nonopioid pain medications are recommended as first-line treatments for chronic pain by the Centers for Disease Control and Prevention (CDC); however, millions of patients take prescription opioids to effectively manage chronic noncancer pain and are at risk for withdrawal if their regimen is decreased significantly or stopped abruptly. When implementing opioid tapering practices, clinicians must not only consider the possibility of withdrawal, but also potential problems such as depression, anxiety, suicide, pain exacerbation, and broken trust. There are many specialty groups that have weighed in with their recommendations on how to best remove chronic opioids from a treatment regimen.
The quest for safe tapering practices that meet the needs of patient, provider, community, and government agencies is challenging and has led to multiple guideline revisions by several groups. In 2016, the CDC released its Guideline for Prescribing Opioids for Chronic Pain, which set forth rigorous standards for prescribing and more aggressive standards for tapering and cessation as a means to combat the opioid crisis. Clinicians complained that these criteria did not leave room for individualized patient pain management and led to negative consequences in some cases, including uncontrolled or inadequately pain, and illicit drug seeking behavior for pain relief.
The most recent update is a patient-focused approach titled, Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics, which was released October 10th by the U.S. Department of Health and Human Services (HHS). This is a compilation derived from previously published guidelines in the literature. The purpose of the new HHS Guide is to strike a balance between adequate pain control, decreased risk for addiction, and effective tapering, when it is time to stop the prescription. The focus is on tailoring therapy practices to the individual pain management needs of each patient, which embodies patient-centered care, one of the Institute of Medicine's (IOM) six aims for improving the healthcare system.
Read More about Opioid Withdrawal:
The Atlas of Emergency Medicine, 4e: Chapter 17. Toxicological Conditions > Opioid Toxicity
Current Diagnosis and Treatment Psychiatry, 3e: Chapter 50. Opioid Use Disorders
Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e: Chapter 186. Opioids
Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 13e: Chapter 20: Opioids, Analgesia, and Pain Management
The U.S. Department of Health and Human Services (HHS): HHS Announces Guide for Appropriate Tapering or Discontinuation of Long-Term Opioid Use