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
- When the risks of opioid treatment outweigh the potential benefits. (See “Risks and Benefits of Opioid Therapy for Chronic Pain,” and “Screening and Assessment Tools“)
- Patient with evidence of using illicit substances (e.g. cocaine), non-prescribed medications (e.g. benzodiazepines), or other risky use of substances (e.g. alcohol).
Katz N. Patient Level Opioid Risk Management: A Supplement to the PainEDU.org 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.