Stopping Opioids

Indications for Stopping Opioid Therapy

Definitive Indications for Stopping Opioid Therapy

  • No benefit identified (See “Assessing the Benefits of Opioid Therapy“).  One does not have to prove diversion or addiction in order to stop opioid therapy.
  • There is evidence of illegal activity or diversion of medication (e.g. forged or stolen prescription).
  • Patient exhibits harms from treatment, such as overdose (intentional or unintentional), over-sedation, constipation requiring hospitalization, etc.
  • Patient cannot keep medications safe (e.g. recurrent stolen medication from family member, recurrent lost medication, etc.).
  • Patient with active addiction requiring treatment (not stable).
  • Violent or abusive behaviors toward practice staff or clinicians.
  • Patient unable or unwilling to comply with monitoring requirements.

Strong Indications for Stopping Opioid Therapy BUT that Require Clinical Judgment

See also:
How to Stop Opioid Therapy
How to Discuss Stopping Opioid Therapy with the Patient
U.S. Department of Veterans Affairs Fact Sheet for Tapering Opioids

Katz N. Patient Level Opioid Risk Management: A Supplement to the Manual. Newton, MA: Inflexxion, Inc.; 2007. Portenoy RK. Opioid therapy for chronic nonmalignant pain: a review of the critical issues. J Pain Symptom Manage. 1996 Apr;11(4):203-217.

Webster LR, Dove B. Avoiding Opioid Abuse While Managing Pain: A Guideline for Practitioners. 1st Edition. North Branch, MN: Sunrise Press; 2007.