Opioid tapering: a conversation guide for Veterans

Before your appointment

The CDC advises clinicians to weigh the benefits and risks of both continuing opioids and reducing them. If benefits outweigh risks, continuing treatment while improving other pain care can be appropriate. Except for a life-threatening concern, opioids should not be stopped abruptly. Read the CDC guidance on continuing opioid therapy.

What should a tapering conversation cover?

Ask what prompted the recommendation and what the team hopes will improve. Bring your own priorities: staying alert while caring for a grandchild, walking to the mailbox, or making it through a shift. Ask how the team will track those goals alongside pain and side effects.

The VA/DoD guidance supports a collaborative approach and finds insufficient evidence to recommend one specific tapering strategy. Your needs, preferences, and ability to attend follow-up should shape the discussion. See the VA/DoD tapering summary.

These questions can help make the next appointment concrete:

• What are the reasons to continue, reduce, or change this medication in my case?
• Who will write the plan and handle refills if both VA and community clinicians are involved?
• What pain treatments will be available before a dose change?
• When will we check in, and who can I reach between visits?
• What symptoms should prompt a call, and when would we slow or pause the plan?

If travel, work, or caregiving makes frequent appointments difficult, say so before agreeing to a schedule. Ask which visits can happen remotely and which need to be in person. Don't assume a referral or a new treatment will be available immediately.

Is rapid opioid tapering recommended?

Routine rapid tapering is not recommended. The CDC warns that abrupt changes can cause harm and emphasizes continued care rather than abandoning patients. Ask your prescriber for an individualized plan instead of trying to meet a percentage reduction found online. CDC answers for patients already taking opioids.

In her 2016 Stanford Health Care talk, Anna Lembke, MD, discusses the harm of abruptly dismissing a patient and the need to remain involved in their care. That principle remains useful; the lecture is not a current dosing protocol. Watch the discussion around 34:36.

What if pain or withdrawal gets worse?

Contact the prescribing team rather than changing the plan yourself. A clinician may need to reassess the symptoms and adjust the pace. The CDC notes that some tapers need to slow or pause. Reduced tolerance also makes returning to an earlier higher dose dangerous. Ask about naloxone and make sure someone close to you knows how to use it. CDC tapering and overdose-prevention guidance.

For suspected overdose, such as inability to wake someone or slow, difficult breathing, use naloxone if available and call 911. Stay with the person and follow emergency instructions. CDC overdose response.

Keep pain care in the plan

Use the appointment to review what has already helped, what hasn't, and what you could realistically try next. Ask about rehabilitation, pain psychology, nonopioid medicines, and support for sleep when relevant. The Veteran chronic pain care guide can help organize those questions.

For example, if a prior exercise plan flared your pain, bring that experience to the clinician. Ask how a new plan would be adapted and how you would report problems. A referral alone doesn't answer those questions.

If you want information about Valor's home-based chronic pain support, use the program inquiry options below and discuss fit with your treating clinician. A Valor inquiry does not arrange an opioid taper or replace medication management. For medication changes, start with the clinician who prescribes them.

About this guide

Prepared from the complete available automatic captions of Doctors and the Opioid Addiction Crisis, including the Q&A, plus selected visuals and current CDC and VA/DoD sources. Stanford Health Care published the talk on November 23, 2016. The appointment questions are editorial additions for Veterans. This educational guide has not received clinical sign-off.