Plan Next Steps
“Consider sequential tapers for patients who are on chronic benzodiazepines and opioids. Coordinate care with other prescribers (e.g., psychiatrist) as necessary. In general, taper off opioids first, then the benzodiazepines” [wa.gov]
Reference
Decide if the ultimate goal for the taper is dose reduction or medication discontinuation. If dose reduction, decide what the final dose goal will be.
Consider starting with reducing Total Daily Dose (TDD) of the patient’s opioid(s) by 10% every 1-2 weeks.
- For patients who have been on opioids for a longer period of time (e.g., years), a slower taper (e.g., 5-10% every 1-2 months) may be warranted in order to minimize withdrawal symptoms.
Resources
- Opioid Information Sheet (UNC resource) [recommended resource]
- Opioid Tapering Resource (AAFP resource)
- Opioid Taper Decision Tool (U.S. Department of Veterans Affairs resource)
- Tapering Long-term Opioid Therapy in Chronic Noncancer Pain (Mayo Clinic resource)
Having a patient and their provider sign an opioid taper agreement ensures that both the patient and the provider know what goal they are working towards and the responsibilities of each party involved.
Resources
- Opioid Taper Agreement (UNC resource)
A taper can also be paused or slowed if withdrawal symptoms persist or are severe.
Resources
- Opioid Information Sheet (UNC resource)
- Opioid Withdrawal: Care Instructions (Epic patient education resource)
- Refer patient to a mental health provider (psychiatrist, psychologist, counselor) or help in the management of pain and/or opioid use disorder.
- Encourage the use of cognitive behavioral therapy (CBT) for increased success in tapering plan.
Having a follow-up plan in place will facilitate tapering success.
*A consultant pharmacist will provide recommendations for these items prior to patient’s clinic visit
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