When I was first approached to help with Opioid Tapering, admittedly I was nervous. I didn't want to make someone do something they were not ready to do. I did not want to be a "bad guy" however as I started to meet with patients and help them through this process my outlook on tapering quickly changed. I learned that most patients don't want to be taking the opioids. I learned that many were started years ago and they wanted to come off them but just didn't know how. I learned that providers wanted to help patients however some did not know where to start. Some providers just wanted more frequent check in and visits with the patient to provide the patient with more of a support.
Unfortunately the opioid addition is real and I have seen the negative affects that it can have on individuals and their families. While opioids can be effective for pain management, they also carry a significant risk of addiction and overdose. As a result, opioid tapers have become an increasingly important aspect of my practice as a pharmacist. I have been doing tapers now for about 7-8 years and have found them to be rewarding not only for me but my patients have as well.
Pain Management Guidelines encourage providers to ensure that the risk does not out weigh the benefits. Doses above 45mg morphine equivalents are considered to have a higher risk than benefit. Providers evaluate the risk by looking at not only the patient's current dose of the opioids but also if a patient is taking other high risk medications. The opioid risk is compounded if other high risk medications (such as muscle relaxants, other pain medications, sleep aids and benzodiazepines/anti-anxiety) are also being taken at the same time. If a provider determines if the opioid is unsafe then they will have discussions with the patient.
Guidelines stress that patients should be included in the discussions for determining the plan moving forward. The options that would be presented to the patient would be to either 1)taper down to a safer dose (less than 45-50mg) or to taper off completely 2) transition to buprenorphine treatment or 3)a referral to pain management.
If a taper is determined to be the next course then the tapers involve slowly reducing a patient's dosage of opioids over time, with the goal of eventually stopping their use altogether. This can be a challenging process for patients, particularly those who have become dependent on opioids. However, it is an essential step in reducing the risk of addiction and overdose.
As a pharmacist, my role in opioid tapers is to work closely with patients and their healthcare providers to create a tapering plan that is safe and effective. This involves carefully assessing the patient's current dosage of opioids, their level of pain, and any potential withdrawal symptoms that they may experience during the tapering process. It is also important to ensure that the patient has access to alternative pain management strategies, such as physical therapy or non-opioid medications.
One of the most important aspects of opioid tapers is communication. I meet weekly to every 2 weeks with patients who are undergoing a taper to monitor their progress and ensure that they are managing their pain effectively. A prescription is only given the amount of opioid to get them until their next appointment with me. So patients only receive a week or a 2 week supply of their opioid at one time.
I not only work closely with the patient, but I also work closely with the patient's providers to adjust the tapering plan as necessary, particularly if the patient is experiencing significant withdrawal symptoms or their pain is not being effectively managed.
Social Work is also beneficial for patients when managing pain as well as during the tapering process. Providers and patients should consider having a Social Worker as part of the solution.
While opioid tapers can be challenging for patients, they are an important step in reducing the risk of addiction and overdose. As a pharmacist, I am committed to working with patients and their healthcare providers to create safe and effective tapering plans that support their health and well-being. By carefully monitoring patients during the tapering process and providing support and guidance along the way, we can help individuals manage their pain while reducing the risk of opioid addiction and overdose.
Here are a few direct quotes from some of the patients I have worked with.
"Honey, I just went through a divorce and my husband used to control me. I don't want anything controlling me anymore and this little white pill controls my day. I' ready for it to be gone and to prove it doesn't control me"
"It's in the mind. Keep going forward and don't go back"
"Try it. It's been good. I've learned it's all about my reaction. I started out a little combative because I was scared and although times have been harder than others, it has been easier than I thought it would be."
By working closely with patients and their providers, I am able to create safe and effective tapering plans that reduce the risk of addiction and overdose. While tapering can be a challenging process, it is an important step in managing pain and promoting overall health and well-being. Overall patients have commented to me that they have appreciated me being there with them during the process and caring. Patient's have stressed that they have felt better once the doses came down and especially when they were able to come off of the opioid entirely.
Note: All patients that take opioids should have Naloxone in their home to have incase of an overdose. Remember Naloxone has just been approved as an OTC (Over the Counter) medication.
**Please take note, my views are my own and are not associated or representative of my employer(s). This website and its associated platforms are for education purposes only and not medical advice. (If one wants to establish a relationship in which individual circumstances can be evaluated please send a message)
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