How to Stop Prescribing Opioids & Manage the Patient with a Different Approach . William R. Morrone, DO, ACOFP, ASAM, DAAPM Consulting Liaison Addictionologist Department of Psychiatry at Wolverine Human Services Asst. Director of Family Medicine at Synergy Medical Education .
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
William R. Morrone, DO, ACOFP, ASAM, DAAPM
Consulting Liaison Addictionologist
Department of Psychiatry at Wolverine Human Services
Asst. Director of Family Medicine at Synergy Medical Education
Are chronic opioids appropriate?
Physical Dependence vs Addiction:
Chemical dependence screening
Monitor for scams
Reassess for appropriateness
Educate patient on need to discontinue opioids
3-month self taper
(document in chart)
10-week structured taper
Discontinue opioids at end of structured taper
Refill flow chart
Occasional urine toxicology
Watch for scams
Instruct patient on withdrawal symptoms
Tell patient to go to ER
if symptoms emerge
1. Note in chart the reason for discontinuing opioids, non-emergency situation, outline of taper, end date for prescribing.
2. Have patient read and initial the note.
3. Prescribe 10% fewer opioid analgesics each week (Appx. J)
4. Reassess on week #8: – If going well, continue. – If not going well, plan detoxification
5. At Week 10: Stop prescribing and educate patient about withdrawal symptoms. Urge the patient to go to the ER if withdrawal appears and admit for detoxification.
What is a physician to do?
Symptoms / Signs
Anxiety, Drug Craving
Yawning, Sweating, Runny nose, Tearing eyes, Restlessness Insomnia
Dilated pupils, Gooseflesh, Muscle twitching & shaking, Muscle & Joint aches, Loss of appetite
Nausea, extreme restlessness, elevated blood pressure, Heart rate > 100, Fever
Vomiting / dehydration, Diarrhea, Abdominal cramps, Curled-up body positionOpioid withdrawal
Appropriate for illicit or prescription opioid abuse with associated physical dependence
Rationale for agonist therapy:
Blocks euphoric effects of other opioids