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29th Napa Pain Conference Sessions

De-prescribing: When, Why, & Getting Patient Buy-in


Aug 19, 2022 2:25pm ‐ Aug 19, 2022 3:05pm


Description

Learning Objectives

As a result of participating in this activity, learners will be able/better-able to: 

  • Identify when to initiate de-prescribing, 
  • Mitigate patient and clinical characteristics which are barriers to tapering.
  • Improve patient buy-in to tapering programs,
  • Reduce or stop opioid therapy when appropriate


Intro

Approximately 650,000 opioid prescriptions are dispensed daily in the United States. 2.5% of veterans under active care receive long-term opioid therapy. in 2015, 4.3Million Americans were taking opioids for chronic, non-cancer pain. Tapering unmasks brain adaptations within the mesolimbic system that were both created and suppressed by long-term opioid therapy.

This session covers reviews the benefits and risks of tapering opioids. 

The mechanics of tapering are complex and have yet to be well-studied in high quality randomized studies. Learn strategies and means to address barriers and pitfalls to tapering regimens. Understand patient views, motivations, priorities, and successful approaches to introduce the topic of tapering to patients. 

Including:

  • Tapering rate and the speed of dose reduction
  • Tapering multiple opioids
  • Alternatives to tapering in stable and unstable patients
  • Chronic, persistent opioid dependence
  • Managing withdrawal symptoms
  • Providing psychosocial support and complementary therapies
  • Medicolegal risks

Additional Reading

  • Davis, M. P., Digwood, G., Mehta, Z., & McPherson, M. L. (2020). Tapering opioids: a comprehensive qualitative review. Ann Palliat Med, 9(2), 586-610.
  • Ballantyne, J. C., Sullivan, M. D., & Koob, G. F. (2019). Refractory dependence on opioid analgesics. Pain, 160(12), 2655-2660.
  • Manhapra, A., Sullivan, M. D., Ballantyne, J. C., MacLean, R. R., & Becker, W. C. (2020). Complex persistent opioid dependence with long-term opioids: a gray area that needs definition, better understanding, treatment guidance, and policy changes. Journal of General Internal Medicine, 35(3), 964-971.
  • Townsend, C. O., Kerkvliet, J. L., Bruce, B. K., Rome, J. D., Hooten, W. M., Luedtke, C. A., & Hodgson, J. E. (2008). A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: comparison of treatment outcomes based on opioid use status at admission. Pain, 140(1), 177-189.
  • Nelson, A. M., Battersby, A. S., Baghdoyan, H. A., & Lydic, R. (2009). Opioid-induced decreases in rat brain adenosine levels are reversed by inhibiting adenosine deaminase. The Journal of the American Society of Anesthesiologists, 111(6), 1327-1333.
  • Cagle, J. G., McPherson, M. L., Frey, J. J., Sacco, P., Ware, O. D., Wiegand, D. L., & Guralnik, J. M. (2020). Estimates of medication diversion in hospice. JAMA, 323(6), 566-568.
  • Pergolizzi Jr, J. V., Rosenblatt, M., Mariano, D. J., & Bisney, J. (2018). Tapering opioid therapy: clinical strategies. Pain Management, 8(6), 409-413.
  • Berna, C., Kulich, R. J., & Rathmell, J. P. (2015, June). Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice. In Mayo Clinic Proceedings (Vol. 90, No. 6, pp. 828-842). Elsevier.

Speaker(s):

  • Mary Lynn McPherson, PharmD, MA, MDE, BCPS, CPE, Professor & Executive Director, Post-Graduate Advanced Education in Palliative Care, School of Pharmacy, University of Maryland

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