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 |