When and How To Wean Off Opioids
Pain Care Part 6: For Injured Workers, it’s possible with the right plan in place
Can injured workers stop using opioids if they no longer help, and then use drug-free options to manage any continuing pain? Yes, if it’s done carefully.
Every year, a million newly injured workers are prescribed powerful painkillers. Tens of thousands of them remain for months, even years, on opioids for pain relief. Opioids work for some, not for others. Patients, doctors, and insurance providers have had to learn how to cut back on these powerful drugs, while minimizing opioid withdrawal symptoms.
Patients on opioids are usually anxious when considering reducing or completely eliminating their prescription, sometimes due to the fear of opioid withdrawal as well as other side effects. But there are compelling reasons for minimizing opioid intake. Patients may be getting some pain relief but their lives have not improved. They may be concerned about the risks of an accidental overdose. Side effects, such as constipation, drowsiness, absence of sexual desire, may burden them. Opioids may have stopped being effective. In short, they want their lives back.
The decision to wean (often called taper) off opioids must be made between the patient and their prescribing doctor. After an extended period on opioids, an abrupt stop is very dangerous. Because not enough research has been done in this area, weaning is in part an art. The doctor may want to consult a pain specialist if she or he does not have that expertise, in order to avoid serious opioid withdrawal symptoms and learn about alternative drug-free therapies.
The State of Washington, which is noted for paying close attention to opioid prescribing, has recommended a multi-step process. Among its suggestions are the following:
- Rapidly wean off the patient, over a two to three week period, if she or he has had a severe adverse experience with the drug, such as an overdose.
- Otherwise, slowly wean, such as by one tenth of a weekly dose per week, and monitor the patient’s functional and pain status.
- Do not reverse the weaning process. Slow down or pause the process if needed.
- Withdrawal symptoms are “rarely medically serious, although they may be extremely unpleasant.” Symptoms may persist for up to six months after completely weaning.
Washington’s guidelines recommend that alternative care be considered before and during weaning. If the patient can receive non-invasive drug-free, yet effective pain treatment in place of medications, it can greatly reduce the negative effects of opioid withdrawal. Drug-free care starts with the proven knowledge that many chronic pain sufferers can regain the rewards of healthy living with the use of a variety of methods that impose essentially no risk of adverse effect. Often the methods used include yoga, meditation, mindfulness, electrotherapy such as H-Wave and exercise.
Claims adjusters and case managers in the workers compensation industry may not know where to get reliable advice on how to talk about weaning with injured workers and their care providers. Here are informative publications that are free and available on the Internet:
Washington State’s Interagency Guideline for Prescribing Opioids
Center for Disease Control’s Pocket Guide for Tapering Opioids for Chronic Pain
Tapering Long Term Opioid Therapy in Chronic Non-cancer Pain