Tips for tapering medicines

It is helpful before making any changes, to understand how the patient is actually using their medication. How do they think it is working for them and how does this fit with the goal of reducing pain intensity and allowing improved function?

It may be useful to provide a short ‘trial’ period after this discussion, before making any changes. This allows the person to consider the new information about pain-relieving medicines provided and think how it might fit with the problems they are experiencing.

“We don’t need to change anything today” can help reduce some of the anxiety the patient may have had on arriving at their appointment.

If a taper is to go ahead, agree with the patient which medicine is going to be reduced, by how much and when the change will start.

Provide information about withdrawal symptoms and actions to take or how the patient can get help should they not feel able to manage them.

Agree when this change will be reviewed and the next change agreed. It is better to agree a single change and review how that has gone before doing the next one, at least initially. This can help grow the patient’s confidence in the process more so than providing a series of reductions that may not feel manageable.

Patients may be sensitive to being labelled

It is important to be careful with the language used when talking about pain-relieving medicines. There are problems with misuse in the United Kingdom and that must not be ignored. However, it can become a barrier to making changes, if the patient feels unfairly labelled when they might simply be seeking support to manage their pain better.

When to make decisions on behalf of a patient

Wherever possible, patients should be actively involved in making decisions about changes to their treatment. However, where there is clear evidence of harm or there is concern the patient is not in a position to make safe decisions about their medicines, there may be a need to reduce medicines without explicit agreement. In that situation, it is even more important that changes are small and made slowly, unless there is immediate risk to life.

Medication review

This training video covers:

  • Patient and clinician agenda setting
  • Assessing self confidence to cope
  • Discovering current use of self management skills / resources
  • Exploring benefits and risks of opioids
  • Agreeing reduction in opioids use

Video duration: 15 minutes