Table 4.

Tapering and Discontinuing Addicting Medications

Baseline

1. Ascertain present dose

2. Negotiate how much patient thinks they need on more severe days

3. Prescribe this amount on a fixed schedule

Taper

1. Negotiate reduction schedule; appropriate to suggest decrease in 1 tablet daily each week, but be prepared to accept up to monthly; e.g., 1 tablet q.i.d. for next week, then 1 tablet t.i.d. the following week, etc.

2. When more than one addicting medication, determine patient's initial preference for reduction or if they prefer simultaneous reduction

Discontinue

1. Simply stop after down to one or one-half tablet daily

2. Most achieve this by 2–4 months, many in 1 month

3. A few cannot psychologically completely stop; appropriate to maintain at lowest dose as long as they have made some reductions

Process

1. Give just enough medication to last until next visit

2. Provide only one “grace period” refill when patient reports losing medication

3. May need written contract for problematic patients

4. Agreement to obtain medications only from the provider