By vgreene, 4 November, 2019 Advise on OD risks if pt abruptly returns to previous higher dose;5 consider naloxone
By vgreene, 4 November, 2019 Follow weekly, set expectations; monitor for w/d; pause/slow taper if needed; regularly re-eval risk-benefit & psycho/social support needs
By vgreene, 4 November, 2019 Rapid taper,2 eg, over 14-21 days: Though w/d may occur, use rapid taper if life-threatening/imminent risk, eg, signs of impending OD/serious event
By vgreene, 4 November, 2019 Faster taper2 over wks: ↓by 10% of original dose qwk until 30% of original dose reached; then ↓by 10% of remaining dose qwk. Consider if hx opioid use for wks/mos
By vgreene, 4 November, 2019 Individualize nonabrupt taper, even if on high doses (>90 MME/d), via shared decision-making. Once min dose reached, ↑interval b/t doses, then d/c once interval
By vgreene, 4 November, 2019 Slower taper2 over mos/yrs: ↓by 5%-20% of original dose q4 wks. Better tolerated, esp w/ opioid use ≥1 year; longer opioid use warrants slower taper