Health officials issue guidance on tapering chronic opioid therapy

  • Dowell D & al.
  • JAMA
  • 10.10.2019

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • The US Department of Health and Human Services has issued new guidelines on how, when, and whether opioid tapering is appropriate in patients with long-term use of opioid analgesics.

Why this matters

  • In March, more than 300 medical experts sent a letter to the CDC arguing that the agency's 2016 opioid prescribing guidelines were harming patients with chronic pain.
  • In April, the CDC clarified its guidelines on opioid prescribing in patients with chronic pain, and a few weeks later, published a letter claiming that the 2016 guidelines had been misused by physicians whose patients use opioids long term but who are not addicted.

Key highlights

  • Avoid rapid tapers or sudden discontinuations of prescription opioids.
  • Ultrarapid detoxification under anesthesia should not be used.
  • Develop a pretaper plan with patients, including identifying possible opioid misuse, behavioral health needs, and nonopioid pain management options.
  • Length of time for tapering will vary depending on the length of prior opioid usage, with common tapers after a dose reduction of 5% to 20% every 4 weeks.
  • Tapering or discontinuation may not be advisable in patients with cancer pain, pain at the end of life, or in other situations in which the benefits of opioid therapy outweigh the risks.