October 17, 2019
On October 10, 2019, the U.S. Department of Health and Human Services (HHS) published a new guide for tapering opioids safely and effectively for patients on long-term opioid therapy. Compiled from strategies and practices endorsed in recent peer-reviewed literature, the “Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics” seeks to provide clinicians with a quick-reference list of things to consider and discuss with patients when choosing to taper opioids. Regardless of whether the patient and provider decide to taper opioids, the Guide encourages providers to integrate nonopioid treatments into pain management plans.
Among other factors, the Guide encourages clinicians to consider tapering or discontinuing therapy when pain and function improves, the patient requests to move off opioids, the patient is exhibiting signs of misuse, or the patient is receiving medications or has medical conditions that increase the risk of an adverse outcome. The decision to taper as well as the taper rate should be tailored to the individual patient’s needs. HHS also instructs providers to avoid dismissing opioid patients from care as this could put patients at high risk, especially in physically dependent patients who may seek opioids from high risk sources.
The Guide also provides education on psychological and behavioral symptoms that could be associated with long-term opioid therapy and withdrawal. It states that treating symptoms of depression and anxiety may help lead to opioid tapering success. Likewise, counseling for and treating symptoms of withdrawal may be necessary to achieve a successful opioid taper.
Furthermore, if the patient shows signs of opioid misuse, the Guide provides a list of 11 criteria from the American Psychiatric Association to consider in a diagnosis of DSM-5 Opioid Use Disorder. Opioid use disorder can lead to clinically significant impairment or distress, and if four or more of the criteria are met, it may be necessary for medication-assisted treatment to discontinue opioid therapy.
With the ongoing opioid crisis, this guide from HHS will serve as an important tool for providers to reference when tapering opioids. Safely and effectively tapering long term opioid treatment when clinically indicated is an important element in preventing further opioid misuse and reducing the negative societal impact of opioid addiction. Although these guidelines do not carry the force of law, they will be the foundation for the standard of care to follow when initiating an opioid taper moving forward.
If you have any questions concerning the HHS Guide or if you need assistance in regulatory matters concerning controlled substances, please contact Jerry Canaan or Hancock Daniel’s Health Regulatory Team.
The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel & Johnson, P.C., is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel & Johnson, P.C. be liable for any direct, indirect, or consequential damages resulting from the use of this material.