Tapering opioids

  • Daily dose of opioid medication exceeds oral morphine equivalent 120mg/24hours.
  • If opioid is not providing useful pain relief it should be discontinued even if no other treatment options are available.
  • If there is an increase in pain following period of stable dosing, and where there is no evidence of malabsorption or disease induced pain progression consider reducing the opioid as unlikely to be beneficial.
  • To check for on-going benefit (e.g. underlying painful condition resolves) or the patient receives a definitive pain relieving intervention (e.g. joint replacement).
  • The patient develops intolerable adverse effects.
  • Strong evidence patient is diverting medication to others or showing drug seeking behaviour e.g. early or lost scripts, asking for dose increases.

How to taper the dose:

  • Reduce slowly. The dose of drug can be tapered by 10% every two weeks – and document the tapering schedule in the patients notes.
  • Patient engagement is essential. Explain rationale to patient e.g. avoidance of long term harms and improvement in ability to engage in self-management strategies. Offer reassurance - often no increase in pain. Monitor for signs and symptoms of opioid withdrawal. Offer regular review and support. Detailed assessment of emotional influences on their pain is essential. See Opioids Aware: Tapering and stopping

Specialist services:

  • Patients prescribed large doses of opioids (greater than oral morphine equivalent of around 300mg/day) may need support from specialist services in order to reduce medication.
  • If patient is willing to engage in dose reduction but specialist support is required consider referral to Pain Clinic.