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opioid deprescribing

Indications: - patient requests opioid taper - risk of continuing opioid outweighs benefit - patient is < 30 year of age, thus more likely to experience adverse effects of chronic opioid therapy - patient has inadequate pain response, functional improvement with moderate dose increases not seen, unbearable adverse effects of opioids, or opioid therapy harms physical, emotional or social function - patient takes other sustances that affect the central nervous system - patient at risk for opioid overdose - patient unable (or unwilling) to follow terms of agreed upon management plan (opioid contract) Procedure: - 15% relative reduction in mean daily dose during any of 6 overlapping 60-day windows within a 7-month follow-up period [3] - alternatively, opioid may be discontinued long enough to produce a mild withdrawal state & sublingual buprenorphine/naloxone (Suboxone)in connection with cognitive behavioral therapy begun [4] Complications: - abrupt discontinuation of long-term opioid use will precipitate opioid withdrawal - opioid taper may increase risk of opioid overdose & mental health crisis [3]

Related

opiate abuse; opioid use disorder opioid maintenance therapy opioid receptor agonist (narcotic)

General

medication deprescribing

References

  1. National Academy of Medicine Tapering Patients on Long-Term Opioid Therapy for Chronic Non-Cancer Pain in Outpatient Settings https://nam.edu/programs/action-collaborative-on-countering-the-u-s-opioid-epidemic/best-practices-opioid-tapering/
  2. Rich R Jr, Chou R, Mariano ER et al Best Practices, Research Gaps, and Future Priorities to Support Tapering Patients on Long-Term Opioid Therapy for Chronic Non-Cancer Pain in Outpatient Settings. National Academy of Medicine. Discussion paper. August 10, 2020 https://nam.edu/best-practices-research-gaps-and-future-priorities-to-support-tapering-patients-on-long-term-opioid-therapy-for-chronic-non-cancer-pain-in-outpatient-settings/
  3. Agnoli A, Xing G, Tancredi DJ Association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids. JAMA. 2021;326(5):411-419 PMID: 34342618 PMCID: PMC8335575 (available on 2022-02-03) https://jamanetwork.com/journals/jama/article-abstract/2782643 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780952
  4. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2022