A Healthesystems publication

Spring 2014

Opioids: A Guide to Tapering and Discontinuation

Healthesystems clinicians reviewed evidence-based guidelines to assemble this reference for tapering and discontinuing opioid therapy.

Long-term opioid use often results in well-documented risks for the injured worker, payer and employer that include dependence, disability and high costs. In many cases, clinicians at a PBM can work with a prescriber to taper and discontinue opioid therapy and minimize or eliminate associated risks. There is limited evidence to support a specific rate of tapering or tapering protocol; however, best practices, recommendations and considerations were captured to create this resource.

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SOURCES

1 -Hegmann, K.T. & Glass, L.S. (Ed.) (2008) Occupational Medicine Practice Guidelines, 2nd Edition. American College of Occupational and Environmental Medicine (ACOEM)
2 -Washington State Department of Labor and Industries. Guideline for prescribing opioids to treat pain in injured workers. Olympia (WA): Washington State Department of Labor and Industries; 2013 Jul 1. 19 p
3 -Chou RT, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130.
4 -Department of Veterans Affairs, Department of Defense. (2010) The Management of Opioid Therapy for Chronic Pain Working Group, VA/DoD Clinical Practice Guideline, Management of Opioid Therapy for Chronic Pain. Washington, DC.
5 -Cowan DT, Wilson-Barnett J, Griffiths P, et al. A randomized, double-blind, placebo-controlled, cross-over pilot study to assess the effects of long-term opioid drug consumption and subsequent abstinence in chronic noncancer pain patients receiving controlled-release morphine. Pain Med. 2005;6(2):113-121.
6 -Hegmann, K.T. & Glass, L.S. (Ed.) (2008) Occupational Medicine Practice Guidelines, 2nd Edition. American College of Occupational and Environmental Medicine (ACOEM)
7 -Hegmann, K.T. & Glass, L.S. (Ed.) (2008) Occupational Medicine Practice Guidelines, 2nd Edition. American College of Occupational and Environmental Medicine (ACOEM)
8 -Clinical Centers of Excellence in Pain Management Awards Program. American Pain Society. http://www.americanpainsociety.org/about-aps/awards/clinical-centers-of-excellence-in-pain-management-awards.html. Accessed February 25, 2014.
9 -Washington State Pain Clinic Instills ‘Don’t Give Up’ Attitude. Pain Medicine News. 2013;11. http://www.painmedicinenews.com/ViewArticle.aspx?d=PRN&d_id=86&i=September+2013&i_id=991&a_id=2394. Accessed February 25, 2014.
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