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(DE)prescribing Opioids

By: Carol Morriscey

Deprescribing opioids, slowing reducing and eventually discontinuing opioid use, is an important tool in addressing the opioid crisis. How Prescription Opioids Led to the Opioid Crisis

Prescriptions opioids have become the go-to solution for a variety of ills in North American society. From cancer pain to chronic pain, we’ve learned to pop a pill to treat it. Unfortunately, the pills which seemed like a quick fix have had devastating effects. The prescription for long-term opioid use have turned out to be an insidious prescription for opioid dependence and addiction. The body becomes accustomed to having high levels of opioids filling its receptors, leading to painful withdrawal symptoms when the prescription expires. When a patient’s opioid use is not tapered properly, many turn to illegal street opioids to avoid the suffering associated with withdrawal. Their opioid prescription has thus turned into a devastating addiction, contributing to the opioid crisis. This troubling process highlights the need to encourage responsible opioid deprescribing among physicians.

De-prescribing Opioids

Although there are processes and guidelines in place for prescribing opioids, the same guidelines do not exist when it comes to reducing or discontinuing a prescription. As such, an initial opioid prescription may be a permanent prescription. If patients are receiving a higher than recommended dose of opioids or experiencing negative side-effects, deprescribing them should be considered. Furthermore, a condition called opioid-induced hyperalgesia, in which pain is worsened though opioid use also warrants opioid deprescription. Opioid dose reduction or cessation should be achieved through tapering. Tapering, or gradually reducing a patient’s dose, will allow them to reduce or eliminate their opioid use while minimizing withdrawal symptoms.

In addition to tapering or eliminating a patient’s opioid use, alternative treatments should be sought. Incorporating physical rehabilitation and psychological counselling will help make the transition more comfortable and promote an opioid-free lifestyle.

Challenges with De-prescribing Opioids

Although opioids treat pain, they do not address the underlying issues which cause the pain. Therefore, when opioid use stops the pain persists, making opioid deprescription challenging. Opioid-free pain treatments should be incorporated in a new treatment plan, which may include massage therapy, physiotherapy, and non-narcotic pain killers. Treating the underlying conditions will help to make opioid deprescription an attainable goal.

The physical dependence that develops after opioid use can also present a barrier for opioid deprescription. In situations where the withdrawal symptoms are unmanageable, the tapering schedule should be reconsidered and alternative treatments investigated.

The Importance of Opioid Deprescription

The over prescription of opioids plays an important role in the opioid epidemic we are currently experiencing. If we are able to put effective opioid deprescription guidelines and practices in place, physicians and patients will be empowered in their fight against opioid use and addiction. These guidelines will allow patients and physicians to address prolonged or high-dose opioid use before it becomes problematic, thus promoting a proactive approach to opioid addiction, and preventing greater harm being done as a result of the opioid epidemic.

If you or someone you know has not been given the resources or support to deprescribe their opioid use, Searidge Foundation is here to help. Our compassionate team of treatment specialists recognizes the challenges which are faced through opioid use, and have a great deal of experience in helping our patients take their life back from opioids.

Need help? Call now to speak to one of our caring counsellors 1-866-777-9614
National Association of Addiction Treatment Providers International Security for Traumatic Stress Studies The Canadian Positive Psychology Association The Association for Addiction Professionals