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Approach to opioid tapering for patients on long-term opioid therapy for pain

This algorithm shows an approach to opioid tapering for patients with chronic pain. For further details refer to UpToDate content on opioid tapering.

CBT: cognitive behavioral therapy; OUD: opioid use disorder; MME: morphine milligram equivalents; LOT: long-term opioid therapy.
* Indications for tapering (ie, risks may exceed benefits) include the following:

Patient taking >90 MME opioid per day
Lack of or loss of therapeutic effect
Patient request
Noncompliance with opioid agreement

¶ Taper slowly to avoid withdrawal, at a rate based on duration of opioid therapy, modified for patient preference and clinical circumstance.

For patients who have been on LOT for <1 year, decrease MME by 10% of starting dose per week.
For patients who have been on LOT for >1 year, decrease MME by 10% of starting dose per month.

Δ Monitor for pain, physical function, withdrawal symptoms, depression, anxiety, suicidal ideation, and progress on opioid dose reduction.

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