Urgent care providers have gotten the message that rampant opioid prescribing has led to a public health crisis rooted in addiction and death. And it’s likely new prescriptions have dropped considerably as a result. However, knee-jerk attempts to stop taking them immediately also poses the threat of “serious harm” to patients, according to the U.S. Food and Drug Administration. Going cold turkey or dropping existing doses too suddenly has led to withdrawal symptoms, uncontrolled pain, psychological distress, and suicide in some patients, the FDA reports. As the agency works on new labeling that spells out how to taper doses safely, with an eye toward discontinuing them completely in patients who have become physically dependent, it issued recommendations for clinicians. The full list is available here, but following are some highlights especially relevant to urgent care:
- Do not abruptly discontinue opioids in patients who are physically dependent. Counsel them to not discontinue the medication on their own without discussing the need for a tapering regimen.
- Ensure ongoing care of the patient and agree on an appropriate tapering schedule and follow-up plan so that patient and provider goals and expectations are clear and realistic.
- When deciding how to discontinue or taper therapy, consider a variety of factors. These include the dose of the opioid the patient has been taking, the duration of treatment, the type of pain being treated, and the physical and psychological attributes of the patient.
- There are no standard opioid-tapering schedules suitable for all patients. A patient-specific plan should be used to taper the dose gradually.
- In general, for patients who are physically dependent on opioids, taper by an increment of no more than 10% to 25% every 2 to 4 weeks. It may be necessary to provide the patient with lower-dosage strengths to accomplish a successful taper.
- Patients who have been taking opioids for shorter time periods may tolerate a more rapid taper.
- Reassess the patient regularly to manage pain and withdrawal symptoms that emerge.
- Monitor patients for suicidal thoughts, use of other substances, or changes in mood during the process.
- When opioid analgesics are being discontinued due to a suspected substance use disorder, evaluate and treat the patient, or refer them for evaluation and evidenced-based treatment of the substance use disorder.
JUCM examined the role urgent care provides might play in treating patients who are opioid-dependent. Read how you can help in The Potential Role of Urgent Care in Addressing the Opiate Epidemic in our archive.