How to Stop Opioid Therapy
Degree of Physical Dependence Dictates How to Stop Opioid Therapy
Patients taking only short acting opioids 4 pills per day (any strength) should be able to stop without a taper.
Patients on long acting medication may need taper.
Patients on >50 mg
equivalents per day may require taper, with higher doses more likely to require a taper.
Morphine Equivalence Calculator
Higher Intensity of Withdrawal Symptoms
Higher steady-state levels
Longer term exposure
Faster rate of medication clearance (i.e. short > long half-life agents)
When NOT to Taper
Evidence of illegal diversion or tampering
Patient with suspected addiction not willing to engage in treatment
Patients without evidence of taking medication (e.g. multiple, negative urine drug screens despite high dose or long acting medication).
Patients on low dose short acting medications
Non-opioid pharmacotherapy may be helpful for some patients who experience physical discomfort from opioid withdrawal.
Indications for Stopping Opioid Therapy
How to Discuss Stopping Opioid Therapy with the Patient
U.S. Department of Veterans Affairs - Pain Management Opioid Taper Decision Tool
Katz N. Patient Level Opioid Risk Management: A Supplement to the PainEDU.org Manual. Newton, MA: Inflexxion, Inc.; 2007.
Webster LR, Dove B. Avoiding Opioid Abuse While Managing Pain: A Guideline for Practitioners. 1st Edition. North Branch, MN: Sunrise Press; 2007.