1. Gould, Kathleen Ahern RN, MSN, PhD

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Providers face many challenges as they address patients' pain management needs in the wake of the opioid crisis. The epidemic, which peaked in recent years, illuminated the fact that medical prescriptions play a significant role in addiction. As providers balance the needs of patients, with the risk of misuse, all are encouraged to take steps that reduce opioid dependence. Significant research and education have addressed this goal, and the outlook has improved. However, pain management is complex, and there are many starting points for improvement. One challenge is considerable, as providers struggle with how to taper patients from taking opioid medications. Tapering may be an option for patients in both acute and chronic care settings and is appropriate for many patients as their pain management and health care needs evolve.


Recently, federal officials from the Department of Health and Human Services (HHS) published new guidelines to help providers find a more balance approach to prescribing, adjusting, or tapering opioids. The HHS1 "Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics" provides advice to clinicians that will help them guide patients toward a reduction in dosage or eventual discontinuation of opioid therapy. The HHS workgroup compiled information from published guidelines such as the 2016 "CDC Guideline for Prescribing Opioids for Chronic Pain"2 and the "VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain"3 and from practices endorsed in the peer-reviewed literature. In a recent interview, coinciding with the release of this document, Dr Brett Giroir, an assistant secretary at the HHS, reminds us that it is possible to address the roots of the addiction crisis while helping people receive the medications they need.4 This new document provides support for a balanced approach to this very common challenge, as it guides providers through the entire process of opioid tapering, including the shared decision-making process as patients and providers discuss treatment plans and options for adjunct care including behavioral and alternative therapies.


The guide provides many definitions, as well as examples of terms, for procedural advice. It provides education and valuable resources and organizations such as the Substance Abuse and Mental Health Services Administration. Links to supporting documents, and information for specific drugs and special populations are also included. An Opioid Tapering flowchart, adapted from the Oregon Pain Guidance Tapering Tools, provides a visual assessment of the benefits and risk of continuing opioids at the current dosage. The entire 5-page document is available as a free download. It is an exceptional resource for clinicians and patients.


Kathleen Ahern Gould, RN, MSN, PhD


Editor - In Chief - DCCN Duxbury, Massachusetts




1. US Department of Health and Human Services. HHS guide for clinicians on the appropriate dosage reduction or discontinuation of long-term opioid analgesics. September 2019. Accessed October 11, 2019. [Context Link]


2. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain-United States, 2016. MMWR Recomm Rep. 2016;65(1):1-49. [Context Link]


3. Department of Veterans Affairs. Department of Defense. VA/DoD clinical practice guideline for opioid therapy for chronic pain, version 3.0, 2017. Accessed October 11, 2019. [Context Link]


4. Joseph A. With a new guide to tapering opioids, federal health officials seek a balanced approach to prescribing. STAT News October 10, 2019. Accessed October 11, 2019. [Context Link]