The opioid epidemic is one of the worst crises currently gripping the country, and much of its roots came from over-prescription. Since 2016, the federal government has been trying to counteract the failures of the pharmaceutical and medical industries by producing guidelines for responsible opioid prescription tapering. Tapering describes slowly lowering doses of ongoing prescriptions until the patient is either no longer dependent or only using the bare minimum.
The Origins of Tapering
The original CDC guidelines for tapering were relatively vague, leaving a lot up to interpretation. Weekly doses were suggested to receive 10-50 percent reductions, with more rapid taperings suggested for post-adverse event. The guidelines did say that long-term opioid users shouldn’t see more than a 10 percent weekly reduction.
In April, the CDC and FDA released some clarifications regarding their guidelines, acknowledging the severe risks that can be caused by tapering doses in cases of chronic pain. The main risk of such practices is psychological, with patients who have developed a dependency on the drug, becoming desperate and seeking opioids from illegal sources, putting them in greater jeopardy.
The New Guidelines
In October 2019, HHS released updated guidelines. These included suggestions for when tapering should be considered, including:
- Pain improves
- Pain fails to improve
- The patient requests dosage reduction or discontinuation
- The dosage is unnecessarily high
- The patient has a history of opioid abuse
- There are serious side effects
- The patient has an adverse effect or overdose
- The patient is receiving medical care that increases the risk of an adverse effect
- The patient is a long-term opioid user
The new guidelines also include a flow chart for how physicians should determine whether or not to implement tapering with their patients, making clear that the patient should be involved in the decision and that all risks and benefits should be considered.
Where Tapering Goes Wrong
While overprescribing opioids can count as medical malpractice, so too can irresponsible tapering. The average reduction rate for tapering between 2016 and 2017 was 27.6 percent per month, nearly triple the CDC’s recommendation of no more than 10 percent. Rapid tapering can lead to serious withdrawal symptoms, many of which can be crippling, including pain, desire for the drug, diarrhea, and vomiting. Slow tapering can help to reduce these symptoms while monitoring the patient’s health and adjusting as need be.