OPIOID MANAGEMENT & DETOXIFICATION

Opioid Management & Detoxification

Reasons for the discontinuation of opioid medications include but are not limited to: lack of medication effectiveness, a decrease in pain level in a stable condition, suspicion or confirmation of abuse/misuse, evidence of illegal or unsafe behaviors, and a person’s own desire to cease therapy. One objective of opioid detoxification is to maintain patient safety and comfort and to minimize withdrawal symptoms during the taper. This includes patient preparation to discontinue opioids. Some commonly described withdrawal symptoms include muscle and joint aches, nausea, anxiety, feelings of hot and cold, and runny nose.

Decisions regarding tapering schedule should be made on an individual basis, faster or slower tapering may be warranted from one person to the next. Prior to initiation of the medication wean/taper, a complete evaluation of the current treatment plan should be completed. This includes things like other concomitant psychological conditions and relevant factors regarding each individual person.

Those taking opioids on a non-daily basis meet criteria and are typically able to discontinue medications without the need to taper. In patients who are on daily opioid therapy, generally a taper by 20-50% of the original dose per week is appropriate. Literature shows that a person needs as low as 20% of the previous day’s dose to prevent withdrawal symptoms. Things like antidepressants may also be considered during this process to control symptoms of anxiety and/or sleep disturbances.

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