What the CDC Guidelines Really Say about Tapering off Opioids
In 2016, the Centers for Disease Control and Prevention (CDC) published, "Guideline for Prescribing Opioids for Chronic Pain." These guidelines are provided to primary-care clinicians treating non-cancer patients suffering from chronic pain. Some physicians follow these guidelines as law instead of recommendations and no longer prescribe opioids. The CDC states that the intent of the publication is to improve communication between patients and clinicians regarding the risks versus the benefits of opioid use as a chronic-pain treatment as well as to help reduce the number of opioid overdoses and deaths.
The CDC recommends the following:
Tapering off medications, especially pain medications, should be individualized. Those who have taken opioids for a short period of time can decrease 10% per week while long-time users of opioids may have to taper off at a much slower pace by decreasing the dosage 10% per month. Tapering off slowly reduces withdrawal symptoms.
The patient should be aware that an increased risk of overdose exists if he/she suddenly increases back to the original dosage during the tapering process.
Extra precaution is imperative if tapering off opioids during pregnancy. Withdrawal symptoms can harm the expecting mother as well as the fetus.
Communication between doctor and patient is important. The patient should be able to talk with the doctor as much as needed and share his/her concerns and needs.
Emotional support is imperative during opioid tapering. The patient should rely on trusted family and friends and/or obtain a referral to a mental-health-care provider.
The patient should be aware that although pain may worsen when beginning the tapering process, it usually gets better after opioid use is completely discontinued.
A taper should not be reversed; however, it can be slowed down if needed.
Once the lowest dose is attained, the length of time between doses should be extended.