A practical guide to tapering opioids

Abstract

Abstract Tapering opioids is one of the most daunting dilemmas in clinical practice today. The decision to taper opioids is based on many factors, including a lack of efficacy, unacceptable risk, perioperative management, noncompliance, or patient preference. Tapering in the perioperative setting is quite common, though more complex in patients previously taking chronic opioid therapy. Outside of a medical emergency, opioid tapers are best managed in an outpatient setting, allowing for adjustments and more long-term nonopioid pain management, if necessary. No single strategy can be applied to all patients, and very few published guidelines are available for reference. Dose reductions and schedules are highly variable across available guidelines and literature. Dose reductions range from 10% to 50%, with a frequency ranging from daily reductions to every 2 weeks. Most guidelines address the concern of preventing physical withdrawal symptoms; however, few address the psychological ramifications of tapering. Individualized regimens and a willingness to adjust schedules and doses allows for improved patient comfort. The goal is to complete tapering without any symptoms of withdrawal; however, this is not always possible. Several available agents may help ameliorate these symptoms, including antihypertensives, antihistamines, antiemetics, antidepressants, anticonvulsants, and antipsychotics. Opioid tapering is rarely easy but should be a manageable process.