Opioid Tapering Flowsheet
Consider opioid taper for patients with opioid MME > 90 mg/d or Methadone > 30 mg/d, aberrant behaviors, significant behavioral/physical risks, lack of improvement in pain and function.
- Frame the conversation around tapering as a safety issue.
- Determine rate of taper based on degree of risk.
- If multiple drugs are involved, taper one at a time (e.g., start with opioids, follow with BZPs).
- Set a date to begin and set a reasonable date for completion. Provide information to the patient and establish behavioral supports prior to instituting the taper. See OPG guidelines.
Basic principle: For longer-acting drugs and a more stable patient, use slower taper. For shorter-acting drugs, less stable patient, use faster taper.
- Use an MME calculator to help plan your tapering strategy. Methadone MME calculations increase exponentially as the dose increases, so Methadone tapering is generally a slower process.
- Long-acting opioid: Decrease total daily dose by 5-10% of initial dose per week.
- Short-acting opioids: Decrease total daily dose by 5-15% per week.
- See patient frequently during process and stress behavioral supports. Consider UDS, pill counts and PDMP to help determine adherence.
- After ¼ to ½ of the dose has been reached, with a cooperative patient, you can slow the process down.
- Consider adjuvant medications: antidepressants, Gabapentin, NSAIDs,Clonidine, anti-nausea, anti-diarrhea agents.
MME for Selected Opioids
|Opioid||Approx. Equianalgesic Dose (oral and transdermal)|