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
• alternatively, opioid may be discontinued long enough to produce a mild withdrawal state & sublingual buprenorphine/naloxone (Suboxone)in connection with cognitive behavioral therapy begun

Complications

• abrupt discontinuation of long-term opioid use will precipitate opioid withdrawal
• opioid taper may increase risk of opioid overdose & mental health crisis

More general terms

• medication deprescribing

Additional terms

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