• Edward C Covington, Charles E Argoff, Jane C Ballantyne, Penney Cowan, Halena M Gazelka, W Michael Hooten, Stefan G Kertesz, Ajay Manhapra, Jennifer L Murphy, Steven P Stanos, and Mark D Sullivan.
• Neurological Center for Pain (Emeritus), Cleveland Clinic, Cleveland, OH. Electronic address: covinge@gmail.com.
• Mayo Clin. Proc. 2020 Oct 1; 95 (10): 2155-2171.

AbstractLong-term opioid therapy has the potential for serious adverse outcomes and is often used in a vulnerable population. Because adverse effects or failure to maintain benefits is common with long-term use, opioid taper or discontinuation may be indicated in certain patients. Concerns about the adverse individual and population effects of opioids have led to numerous strategies aimed at reductions in prescribing. Although opioid reduction efforts have had generally beneficial effects, there have been unintended consequences. Abrupt reduction or discontinuation has been associated with harms that include serious withdrawal symptoms, psychological distress, self-medicating with illicit substances, uncontrolled pain, and suicide. Key questions remain about when and how to safely reduce or discontinue opioids in different patient populations. Thus, health care professionals who reduce or discontinue long-term opioid therapy require a clear understanding of the associated benefits and risks as well as guidance on the best practices for safe and effective opioid reduction. An interdisciplinary panel of pain clinicians and one patient advocate formulated recommendations on tapering methods and ongoing pain management in primary care with emphasis on patient-centered, integrated, comprehensive treatment models employing a biopsychosocial perspective.Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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