January 8, 2019
The U.S. Department of Health and Human Services (HHS) recently published a new guide for healthcare providers focused on helping to discontinue or reduce the dosage of long-term opioids. The HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics offers guidance for determining when opioid tapering is appropriate, steps to take before tapering opioids, schedules for both slow and fast tapers, and an opioid tapering flowchart. The guide also gives suggestions for treating symptoms of opioid withdrawal and supporting the patient through behavioral health support. The document draws from guidance published by the Centers for Disease Control and Prevention, as well as the Veterans Administration.1
Approximately 11 percent of U.S. adults report daily pain, and an estimated three to four percent use long-term opioids to help manage chronic pain.2 Reducing dose or discontinuing opioids may be the right choice for patients when risks of opioid use outweigh its benefits.1 In 2017, prescription opioids were involved in 17,029 of the 47,600 opioid-related overdose deaths. Nearly two million U.S. individuals have a prescription opioid use disorder.2 After reducing or ending opioid use, many patients report improvements in function, sleep, anxiety, and mood without worse pain or even less pain.1
Careful and controlled tapering is critical. Rapid or immediate changes in dose can be harmful to patients and puts them at risk for significant withdrawal symptoms, exacerbation of pain, and psychological distress. They may even seek other sources of opioids. HHS recommends abrupt discontinuation of opioids only in life-threatening cases.1
Healthcare providers should discuss risks, benefits, and adverse effects of continued opioid therapy, and include patient concerns in taper planning. They should also coordinate across the patient’s entire care team. When prescribing or tapering opioids, having valuable clinical information about a patient’s opioid use and prescribing history is critical to success. hc1 Opioid Advisor™ provides automated, intelligent data, so healthcare providers can make useful comparisons in real-time with a single click. Learn more and request a demo here.