There is very little guidance on withdrawing or tapering opioids in chronic pain (not caused by cancer). People can fear pain, withdrawal symptoms, a lack of social and healthcare support, and they may also distrust non-opioid methods of pain management.

This can mean that patients receive repeat opioid prescriptions for extended periods of time.

In this podcast, Harbinder Sandhu, health psychologist in pain management at Warwick Medical School, Andrea Furlan, associate professor of medicine at University of Toronto, and Sam Eldabe, consultant in pain medicine at The James Cook University Hospital join us to set out the evidence on tapering opioids - and give practical advice on how to support patients. We're also joined by Colin, who was prescribed opioids for a decade, before he decided to reduce his usage.


What you need to know:

For people with chronic pain and who do not have cancer, the benefits of long term opioids are outweighed by the issues of tolerance, dependence, and the requirement for higher doses

Tapering is the gradual reduction of opioids with the aim of limiting withdrawal symptoms; it may target complete discontinuation of the opioid, or on occasion a reduction of the dose

It is not clear how best to support people to taper their opioids; whether it is best done by interdisciplinary pain management programmes, buprenorphine substitution, or behavioural interventions


Read the full uncertainties paper:
https://www.bmj.com/content/362/bmj.k2990