Medically supervised taper for ultra high-dose opioids with significant comorbidities using a multidisciplinary
Denise Wilkes1, Jasmine M Mitchell2, Kip John Winden3
1Department of Anesthesiology, Pain Clinic, University of Texas Medical Branch, Galveston, Texas.
Journal of Opioid Management
|March 3, 2022
Summary
This case report details a successful medically supervised opioid taper for a patient on ultra high-dose opioids. The approach managed pain and side effects, demonstrating effective ultra-high-dose opioid tapering strategies.
Area of Science:
- Pain Management
- Pharmacology
- Clinical Case Studies
Background:
- The opioid epidemic necessitates effective strategies for tapering patients on chronic noncancer pain medication.
- Limited guidance exists for tapering patients prescribed ultra high-dose opioids.
- Current guidelines address general opioid tapering but lack specificity for extreme doses.
Observation:
- A 53-year-old male with chronic low back pain was on a morphine equivalent daily dose (MEDD) of 1,990 mg.
- The patient experienced significant side effects including nausea, irritability, psychomotor depression, and functional impairment.
- A 12-day medically supervised inpatient opioid taper was initiated.
Findings:
- The patient was discharged with a reduced MEDD of 392 mg.
- Further outpatient tapering reduced the MEDD to 200 mg.
- The taper successfully managed pain and resolved side effects without significant withdrawal.
Implications:
- This case highlights a viable approach for tapering patients on ultra high-dose opioids.
- Medically supervised tapers can be effective in managing complex pain and reducing opioid dependence.
- Findings suggest that structured tapering can improve patient outcomes and quality of life.
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