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If tapering is required after a shorter period of opioid treatment ie, less than 3 months, or if treatment goals of an opioid trial have not been achieved, then a faster rate of tapering is recommended,7 that is, reducing the daily opioid dose each week by 10%–25% of the dose you are starting the taper from.
However, if tapering is required in response to significant adverse effects, daily stepwise reduction may be more appropriate.7
In situations where longer term opioid treatment has been maintained (often for many years) without meaningful improvement in pain and function, the recommended approach is slow tapering and stopping completely if possible.
One practical strategy is to reduce the daily opioid dose each month by 10%–25% of the dose you are starting the taper from. Reducing the dose by 10%–25% each month may allow cessation in 3–9 months.7
Where the formulation is not easily reduced eg, transdermal formulations, and cannot be stopped without risking withdrawal symptoms, changing to a new opioid may need to be considered.
Consider specialist advice when changing opioid treatment.
Regular monitoring is essential during the tapering process. Tapering does not always follow a linear path and the patient’s progress and challenges may determine whether to slow the tapering rate, maintain or pause the taper.
During each review it’s important to review the patient’s goals, emphasise the benefits of tapering and assess the risk of side effects or harm. Of course, if more frequent reviews are expected, the associated time and cost will need to be discussed with the patient.
Establish success criteria
Tapering may be considered successful as long as the patient is making progress,3 eg, if agreed goals are being met. Success will often depend on how realistic the patient’s pain management goals are while they are coming off opioids. It is generally recommended that to be useful, goals should not only be personally relevant but specific, achievable and measurable.19
Equally, it may be useful for prescribers and patients to discuss the real possibility of tapering challenges without couching these in terms of ‘failure’.
If the patient encounters challenges with tapering, consider re-evaluating the tapering plan or seeking specialist advice. If a patient is having difficulty with tapering because of withdrawal symptoms the rate of taper may need to be slowed down to help reduce and manage these symptoms.
Building on each patient’s support network is crucial for successful opioid tapering. This includes involving friends, family, carers and pain support groups.8
Tapering takes time and patience
Opioid tapering is a marathon not a sprint. It is important to acknowledge that complete cessation of opioids may not be feasible or appropriate for all patients. An opioid taper can always be stopped and resumed at a later date if the patient is experiencing challenges.
An alternative approach to tapering in these patients is to reduce to the lowest effective dose where the benefits of treatment outweigh the risk of harm, as any dose reduction may be beneficial.3,7,15