Reduce Dose

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)
Alternatives to Opioids [VIDEO 7:13] (UNC resource)
Pain Medicine: Care Instructions (Epic patient education resource)

Resources

Safe Drug Storage and Disposal (UNC Health Care resource)
Drug Disposal Options (FDA resource)
Safe Use, Storage, and Disposal of Opioid Drugs (FamilyDoctor.org resource)
Learning About Safely Storing and Getting Rid of Opioid Pills and Patches (Epic patient education resource)

Some patients may experience withdrawal symptoms during the tapering process. Educating patients about common withdrawal symptoms and how these symptoms can be mitigated can help facilitate a successful taper.

Resources

Opioid Information Sheet (UNC resource)
Opioid Withdrawal: Care Instructions (Epic patient education resource)

Implement plan for opioid tapering and initiation of any alternate or additional therapies

Educate patient on how to store and dispose of unused opioids appropriately

Educate patient about signs/symptoms of withdrawal or re-emergence of their disease symptoms

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