Table 4.
Recommended considerations for tapering opioid regimens after acute painful episodes.
| Regimen Component | Approach for Opioid-Naïve | Approach for Opioid-Tolerant |
|---|---|---|
| Goals of opioid tapering | Limit excess exposure to opioids and opioid-related adverse events once pain is improving, limit conversion to persistent opioid use if not otherwise indicated by patient condition, limit quantity of unused opioids | More complex and patient-specific, may entail tapering back to previous chronic pain or MOUD regimen (or reevaluating chronic regimen in concert with applicable prescriber), limiting opioid-related adverse events, avoiding relapse of OUD, limiting long-term adverse events related to chronic opioid exposure |
| Dose reduction at each step of taper | Consider decreasing daily dose by 20–25% | More gradual reductions may be needed at each step |
| Frequency of tapering | Every 1–2 days once pain is improving | Less frequent reductions are likely to be needed, consider every 2–7 days once acute pain improving |
| Total duration of taper | Most patients can successfully taper off opioids within 3–7 days after a major scheduled surgery, assuming multimodal and enhanced recovery techniques are used concurrently | Longer tapers will be needed, may take weeks to months to be successful depending on patient-specific circumstances |
| Other considerations | Consider reducing dose before lengthening dosing interval to help maintain smoother pain control without large peaks/valleys of analgesic effect | More multimodal therapies, psychosocial support, monitoring, and coordination of care often needed |