Indications for Stopping Opioid Therapy
Definitive Indications for Stopping Opioid Therapy
No benefit identified (See “
Assessing the Benefits of Opioid Therapy
“). One does not have to prove diversion or addiction in order to stop opioid therapy.
There is evidence of illegal activity or diversion of medication (e.g. forged or stolen prescription).
Patient exhibits harms from treatment, such as overdose (intentional or unintentional), over-sedation, constipation requiring hospitalization, etc.
Patient cannot keep medications safe (e.g. recurrent stolen medication from family member, recurrent lost medication, etc.).
Patient with active addiction requiring treatment (not stable).
Violent or abusive behaviors toward practice staff or clinicians.
Patient unable or unwilling to comply with monitoring requirements.
Strong Indications for Stopping Opioid Therapy BUT that Require Clinical Judgment
When the risks of opioid treatment outweigh the potential benefits. (See “
Risks and Benefits of Opioid Therapy for Chronic Pain
,” and “
Screening and Assessment Tools
Patient with evidence of using illicit substances (e.g.
), non-prescribed medications (e.g.
), or other risky use of substances (e.g.
How to Stop Opioid Therapy
How to Discuss Stopping Opioid Therapy with the Patient
U.S. Department of Veterans Affairs - Pain Management Opioid Taper Decision Tool
These recommendations are based on expert consensus.
Webster LR, Dove B. Avoiding Opioid Abuse While Managing Pain: A Guideline for Practitioners. 1st Edition. North Branch, MN: Sunrise Press; 2007.