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Criteria for recommending opioid tapering or discontinuation in patients on long term opioid therapy for chronic pain

Criteria for recommending opioid tapering or discontinuation in patients on long term opioid therapy for chronic pain
  1. Inability to maintain analgesia despite reasonable dose escalation
  1. Intolerable adverse effects at dose that produces effective analgesia with unsuccessful attempts to use alternate opioids
  1. Deterioration in physical, emotional, or social functioning attributed to opioid therapy
  1. Persistent noncompliance with patient treatment agreement
    1. Taking doses larger than those prescribed
    1. Increasing dose without consulting the clinician
    1. Misusing alcohol or illicit drugs
    1. Injecting or inhaling oral, transdermal, topical, or sublingual formulations
    1. Obtaining medications illegally or inappropriately (illegal opioid dealers, forged prescriptions, family members, the internet, multiple clinicians, multiple pharmacies)
    1. Selling prescription medications or illegal drugs
    1. Not adhering to nonpharmacologic components of treatment or refusing monitoring (eg, pill counts, urine drug testing, or opioid use contract)
    1. Behaving in a manner that is intimidating or threatening to care providers
  1. The pain has resolved
  1. Any patient who is taking greater than 90 MME or concurrently using additional sedative medications
MME: morphine milligram equivalent.
Adapted from: Substance Abuse and Mental Health Services Administration. Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12-4671. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.
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