Opioid Tapering/Detoxification Protocols, A Compendium: Narrative Review.
David A Fishbain1,2,3
1Departments of Psychiatry, Miller School of Medicine at the University of Miami, Miami, Florida, USA.
Pain Medicine (Malden, Mass.)
|April 16, 2021
Summary
This review compiles and compares opioid tapering protocols to guide clinicians. The simplest method uses the current opioid, avoiding rotation errors and offering behavioral benefits.
Area of Science:
- Pain Management
- Addiction Medicine
- Clinical Pharmacology
Background:
- The opioid epidemic necessitates effective strategies for tapering chronic pain patients (CPPs) off opioids.
- Lack of standardized tapering protocols contributes to rapid or forced opioid discontinuation.
- Clinicians require clear guidance on managing opioid tapering in outpatient settings.
Purpose of the Study:
- To compile and categorize published opioid tapering and detoxification protocols.
- To compare the advantages and disadvantages of different protocols for outpatient use.
- To address common clinical questions regarding opioid tapering.
Main Methods:
- A narrative review of published literature was conducted using terms related to opioid tapering and detoxification.
- Searches identified 1,922 abstracts, with 301 reviewed in detail.
- 104 studies were included, and nine types of protocols were identified and compared.
Main Results:
- Nine distinct opioid tapering protocols were identified and compared.
- Protocols were organized into general types with their respective advantages and disadvantages.
- Twenty-two common questions concerning opioid tapering were addressed.
Conclusions:
- The simplest and most advantageous protocol involves tapering using the patient's current opioid.
- This method avoids opioid rotation, thereby preventing potential errors.
- Utilizing the current opioid offers additional behavioral advantages for patients undergoing tapering.
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