The Opioid Crisis and The Role Pharmacists Can Play in Tapering Patients off Narcotics

When should you begin to taper doses of opioids being used to treat chronic pain? The Center for Disease Control has a plan of action for such a situation.

The first thing to do is stay in touch with patients to see how well the opioids are working and if they can be tapered or even eliminated.

According to the CDC, opioid dosages should be tapered under the following circumstances:

• If the patient asks to reduce the dosage.
• If there is no clinically meaningful improvement in the pain. An example of this would be at least a 30 percent improvement on the three-item Pain, Enjoyment, General Activity (PEG) scale.
• If the patient is taking more than 50 MME a day and there is no change, or the patient is taking opioids along with benzodiazepines.
• If the patient is showing signs of drug abuse, such as having problems at work or at home because of drug use or problems controlling their use of the drug.
• If the patient overdoses on the drug.

Plans for tapering the drug should be customized for the patient. The goal of the plan should be to curtail withdrawal symptoms as much as possible, while at the same time offer as much relief from pain as possible without the use of medication.

Tapering should be done slowly. In the early stages, healthcare providers should lower the dose about 10 percent a week. If the patient has been using opioids for a long time, the tapering should be done even more gradually; 10 percent a month, for example.

The healthcare provider should also coordinate their efforts with specialists and treatment experts, especially for higher-risk patients, such as pregnant women or people who have an opioid disorder.

Patients should also receive counseling from mental health providers as part of the tapering effort. The tapering should include treatment for opioid use disorder if necessary, and naloxone should be available to prevent overdose. Healthcare providers should be alert for signs of depression, anxiety or opioid use disorder in the patient. Patients also need a lot of encouragement.

How fast the opioid is tapered and how long the process goes depends on the response of the patient. The healthcare provider should never increase the dosage once he has begun to taper the drug; however, he can slow it or pause it while assessing the withdrawal symptoms.

When the process has reached the point where the patient is receiving the smallest dose possible, the time between dosages can be stretched out, and the administration of the drug can be stopped after the patient has been receiving it less than once a day.

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