Best Practices in Tapering Methods in Patients Undergoing Opioid Therapy

Abstract

The prescribing of opioids for chronic non-cancer pain has escalated over recent years. This pattern has led to a larger number of patients who require discontinuation of opioid therapy. The purpose of this review was to provide an overview of best practices for tapering opioid therapy in patients. A systematic review of the current literature concerning tapering of opioid therapy was performed from 2000-2013. 24 studies were selected for review. Considerable variation was found with regard to taper rate and duration. Taper rate ranged from an initial 20-50% daily reduction in opioid dose to a 5% reduction in dose every one to four weeks. The most common titration rate was a 10% reduction in the daily dose each day. General themes were to individualize taper parameters to ensure patient compliance and presentation of withdrawal symptoms, to slow the rate of the taper to about 1/3 of the original dose, and advise a referral of addicted and complex patients to appropriate specialists for treatment. The majority of available information on tapering opioid therapy consists of clinical guidelines that have been created based on practice experience. There is a need for additional experimental research to develop a more standardized taper protocol.