Features and overview

Slowest taper is done over years. In the slowest taper, reduce opioid by 2 to 10% every 4 to 8 weeks with pauses in taper as needed. Consider the slowest taper for patients taking high doses of long-acting opioids for many years. An example of the slowest taper is given below. During the first month in the slowest taper, 5% reduction of morphine SR 90 mg Q8h = 270 MEDD consists of 90 mg SR qam, 75 mg for noon, 90 mg qpm. Continue the taper based on Veteran response. Pauses in the taper may allow the patient time to acquire new skills for management of pain and emotional distress while allowing for neurobiological equilibration. The subsequent monthly dosage for the slowest taper is 75 mg SR qam, 75 mg noon, 90 mg qpm for month 2; 75 mg SR (60 mg+15 mg) Q8h for month 3; 75 mg SR qam, 60 mg noon, 75 mg qpm for month 4; 60 mg SR qam, 60 mg noon, 75 mg qpm for month 5; 60 mg SR Q8h for month 6; 60 mg SR qam, 45 mg noon, 60 mg qpm for month 7; 45 mg SR qam, 45 mg noon, 60 mg qpm for month 8; 45 mg SR Q8h for month 9. Continue following this rate of taper until off the morphine or the desired dose of opioid is reached.

Question: How long does the slowest taper take?
Answer: over years

Question: How much opioid to reduce in the slowest taper?
Answer: 2 to 10% every 4 to 8 weeks with pauses in taper as needed

Question: For whom should the slowest taper be considered?
Answer: patients taking high doses of long-acting opioids for many years

Question: 5% opioid reduction of morphine SR 90 mg Q8h = 270 MEDD during the first month in the slowest taper consists of what?
Answer: 90 mg SR qam, 75 mg for noon, 90 mg qpm

Question: Clinicians should continue the slowest taper based on what?
Answer: Veteran response

Question: What can allow the patient time to acquire new skills for management of pain and emotional distress while allowing for neurobiological equilibration?
Answer: Pauses in the taper

Question: How may pauses in the slowest opioid taper help the patient?
Answer: allow the patient time to acquire new skills for management of pain and emotional distress while allowing for neurobiological equilibration

Question: When reducing 5% of morphine SR 90 mg Q8h = 270 MEDD, what dose should be taken on month two of the slowest opioid tapering?
Answer: 75 mg SR qam, 75 mg noon, 90 mg qpm

Question: When reducing 5% of morphine SR 90 mg Q8h = 270 MEDD, what dose should be taken on month three of the slowest opioid tapering?
Answer: 75 mg SR (60 mg+15 mg) Q8h

Question: When reducing 5% of morphine SR 90 mg Q8h = 270 MEDD, what dose should be taken on month four of the slowest opioid tapering?
Answer: 75 mg SR qam, 60 mg noon, 75 mg qpm

Question: When reducing 5% of morphine SR 90 mg Q8h = 270 MEDD, what dose should be taken on month five of the slowest opioid tapering?
Answer: 60 mg SR qam, 60 mg noon, 75 mg qpm

Question: When reducing 5% of morphine SR 90 mg Q8h = 270 MEDD, what dose should be taken on month six of the slowest opioid tapering?
Answer: 60 mg SR Q8h

Question: When reducing 5% of morphine SR 90 mg Q8h = 270 MEDD, what dose should be taken on month seven of the slowest opioid tapering?
Answer: 60 mg SR qam, 45 mg noon, 60 mg qpm

Question: When reducing 5% of morphine SR 90 mg Q8h = 270 MEDD, what dose should be taken on month eight of the slowest opioid tapering?
Answer: 45 mg SR qam, 45 mg noon, 60 mg qpm

Question: When reducing 5% of morphine SR 90 mg Q8h = 270 MEDD, what dose should be taken on month nine of the slowest opioid tapering?
Answer: 45 mg SR Q8h

Question: For how long should the determined rate of the slowest opioid taper be followed?
Answer: until off the morphine or the desired dose of opioid is reached