Features and overview

When formulating an opioid taper plan, determine if the initial goal is a dose reduction or complete discontinuation. If the initial goal is determined to be a dose reduction, subsequent regular reassessment may indicate that complete discontinuation is more suitable. Several factors go into the speed of the selected taper. Slower, more gradual tapers are often the most tolerable and can be completed over several months to years based on the opioid dose. The longer the duration of previous opioid therapy, the longer the taper may take. Most commonly, tapering will involve dose reduction of 5% to 20% every 4 weeks. More rapid tapers may be required in certain instances like drug diversion, illegal activities, or situations where the risks of continuing the opioid outweigh the risks of a rapid taper. Document the rationale for the opioid taper and the opioid taper schedule in the Veteran’s medical record. Provide opioid overdose education and prescribe naloxone to patients at increased risk of overdose. Strongly caution patients that it takes as little as a week to lose their tolerance and that they are at risk of an overdose if they resume their original dose. Patients are at an increased risk of overdose during this process secondary to reduced tolerance to opioids and the availability of opioids and heroin in the community.

Question: When formulating an opioid taper plan, what can be the initial goal?
Answer: dose reduction or complete discontinuation

Question: If the initial goal is determined to be a dose reduction, what may indicate that complete discontinuation is more suitable?
Answer: subsequent regular reassessment

Question: Which tapers are often the most tolerable?
Answer: Slower, more gradual tapers

Question: Which tapers can be completed over several months to years?
Answer: Slower, more gradual tapers

Question: How long does it take to complete slower tapers?
Answer: several months to years

Question: Slower, more gradual tapers can be completed over several months to years based on what?
Answer: the opioid dose

Question: Most commonly, tapering involves dose reduction of how much every 4 weeks?
Answer: 5% to 20%

Question: Tapering will involve dose reduction of how much?
Answer: 5% to 20% every 4 weeks

Question: In which instances more rapid tapers may be required?
Answer: drug diversion, illegal activities, or situations where the risks of continuing the opioid outweigh the risks of a rapid taper

Question: Which tapers may be required in certain instances like drug diversion?
Answer: More rapid tapers

Question: Which tapers may be required in certain instances like illegal activities?
Answer: More rapid tapers

Question: Which tapers may be required in certain instances like situations where the risks of continuing the opioid outweigh the risks of a rapid taper?
Answer: More rapid tapers

Question: Which tapers may be required in certain instances like drug diversion, illegal activities, or situations where the risks of continuing the opioid outweigh the risks of a rapid taper?
Answer: More rapid tapers

Question: When the risks of continuing the opioid outweigh the risks of a rapid taper, which tapers may be required?
Answer: More rapid tapers

Question: What to document in the Veteran’s medical record?
Answer: the rationale for the opioid taper and the opioid taper schedule

Question: What to provide to patients at increased risk of overdose?
Answer: opioid overdose education

Question: What to prescribe to patients at increased risk of overdose?
Answer: naloxone

Question: Whom to provide opioid overdose education?
Answer: patients at increased risk of overdose

Question: Whom to prescribe naloxone?
Answer: patients at increased risk of overdose

Question: How long does it take to lose tolerance?
Answer: as little as a week

Question: If the patients under opioid taper pna resume their original dose, they are at risk of what?
Answer: an overdose