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Secrets of Opioid Tapering

I’ve had the opportunity to work with chronic pain patients and opioid tapering.  It has been very challenging and I have definitely picked up a few pearls and strategies to try to help coach patients along the process.  I recently shared some of these pearls and more at a conference when I presented The Art and Science of Opioid Tapering; if you have any interest in booking me for an event, please feel free to reach out here. The VA also has put out this helpful toolkit that you should check out! Here’s a few secrets of opioid tapering that I’ve learned. 

  1. Withdrawal is very real and is very scary for patients.  You need to work with patients on a strategy that they can embrace.  Avoiding (if possible) or at least minimizing withdrawal symptoms is going to help your patient get to goal.  Recommendations for reductions lie in the 5-20% range at a time to help minimize withdrawal.
  2. Length of time between between reductions.  This can certainly vary between patients, but 2-4 week intervals for reduction is usually a place to start.  I try to remember that patients didn’t get to higher dose opioids in a matter of a few weeks, and they will likely not be able to get off opioids in a few weeks.  Plan on months, to maybe even a few years to get off of opioids (if that is the eventual goal)
  3. Understand life situations.  If the patient has a reason for an acute increase in pain, or has a surgery planned, this may not be a good time to do a reduction.  Have some patience and wait a few weeks for the event to stabilize prior to reinitiating the opioid taper
  4. Dosage forms.  Dosage forms can be very challenging especially as we get down to lower dosages.  Getting creative with splitting tablets (if possible) or extending dosing intervals can help patients who are desiring to get off opioids altogether.
  5. Motivational interviewing – Figuring out what is important to the patient and why they want to get off of opioids is a really important aspect of what I do as a pharmacist in this role.  Letting the patient guide the taper process and take control can be empowering for some patients.  If the patient wants you to direct them, I generally give a couple of options for them to consider to help them feel as if they are taking control of what they want to do.  Celebrating success and looking back at how far a patient has come is another thing that I do feel is beneficial for some patients.

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Written By Eric Christianson

May 16, 2018

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