Patient-centered prescription opioid tapering in community outpatients with chronic pain

Researchers from the Stanford University School of Medicine conducted a study of voluntary, patient-centered opioid tapering in outpatients with chronic pain without behavioral treatment. In all, 82 of 110 eligible patients agreed to taper their opioid dosages.

Researchers from the Stanford University School of Medicine conducted a study of voluntary, patient-centered opioid tapering in outpatients with chronic pain without behavioral treatment. In all, 82 of 110 eligible patients agreed to taper their opioid dosages. Participants were given a self-help book on reducing opioid use as well as a slow, customized taper in opioid use. Among the 51 patients who completed the study, the baseline median morphine equivalent daily dose (MEDD) was 288, with a median 6-year duration of opioid use. The median MEDD dropped to 150 after 4 months. According to the researchers, the likelihood of more than 50% opioid dose reduction was not predicted by starting dose, baseline pain intensity, years prescribed opioids, or any psychosocial variable. In addition, neither pain intensity nor pain interference increased with opioid reduction. The findings, note the researchers, "challenge common notions that patients taking high-dose opioids will fail outpatient opioid tapers or that duration of opioid use predicts taper success. Combining patient education about the benefits of opioid reduction with a plan that reduces opioids more slowly than current tapering algorithms with close clinician follow-up may help patients engage and succeed in voluntary outpatient tapering."