(music)
- [Narrator] For patients prescribed
continuing opioid therapy
for chronic non-cancer pain,
providers should evaluate benefits
and risks after one to four weeks initially
and every three months or more often thereafter.
If you find that benefits do not outweigh risks
of continued opioid therapy, consider initiating
a discussion with your patient about whether
to taper opioids to lower dosages
or to taper and discontinue opioids.
Although there are many instances where tapering may
be needed, sometimes tapering opioids isn't the best option.
The CDC guideline for prescribing opioids
for chronic pain does not recommend opioid discontinuation
when benefits of continued opioid therapies outweigh risks.
Consider your patient's diagnosis,
circumstances, and unique needs.
For pregnant women, opioid withdrawal
risks include spontaneous abortion and premature labor.
Access appropriate expertise if considering opioid tapering
or managing opioid use disorder during pregnancy.
If you as the provider think that tapering
is needed, or if your patient requests
an opioid dosage reduction, start by having
a conversation with your patient.
Patient collaboration and buy-in are important
to successful tapering.
Let patients know that they may
experience improved function,
sleep, anxiety and mood without worsening pain,
or even with decreased pain after a taper,
even though pain might initially get worse.
Once a mutual decision has been made,
individualize the tapering plan,
considering risk factors for opioid-related harms,
duration of the taper, and how you will handle pausing
and restarting if necessary.
Tapers may be slowed or paused, but should not be reversed.
Avoid abrupt tapering or sudden discontinuation of opioids.
Use a taper slow enough to minimize withdrawal symptoms.
A reasonable starting point for a patient who
has taken opioids for more than a year would
be a dosage reduction of 10% per month.
If a patient has taken opioids for only
a few weeks or months, a reduction
of 10% per week may be reasonable.
Because it takes as little as a week to lose tolerance,
advise your patient that there is an increased risk
for overdose if they abruptly begin taking
a previously-prescribed higher dose after beginning a taper.
For patients who have experienced overdose
on their current opioid dosage, a more rapid taper over
the course of two to three weeks might be needed.
You can support your patients during
the tapering process in the following ways.
Schedule follow-up appointments frequently,
for example, once a week.
And establish a multidisciplinary approach
to pain management.
This can include nonpharmacological options,
such as exercise and nonopioid therapies,
which have been shown to be effective
in managing chronic pain.
Provide psychological support,
especially cognitive behavioral therapy.
If needed, work with mental health providers,
arrange for treatment of opioid use disorder,
and offer Naloxone for overdose prevention.
Finally, monitor your patient for depression,
suicidal ideation, anxiety and opioid use disorder during
the tapering process.
Treating comorbid mental health disorders can improve
the likelihood of opioid tapering success.
Remember that collaboration is an ongoing process.
Continue to work with your patient
to weigh the benefits and risks of opioids,
and to make decisions about whether to continue
at the current dosage, taper and continue
at a lower dosage, or taper and discontinue opioid therapy.
For more information about opioid tapering, see Module 6:
Dosing and Titration and Applying CDC's Guideline
for Prescribing Opioids training series.
CDC also offers a tapering Pocket Guide
for your convenience.
Finally, refer to the HHS Guide for Clinicians
on the appropriate dosage reduction
or discontinuation of long-term opioid analgesics
for specific guidance on conducting a taper.
Access these resources on the CDC website.
Thank you.