HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics 1
HHS Guide for Clinicians on the
Appropriate Dosage Reduction
or Discontinuation of
Long-Term Opioid Analgesics
This HHS Guide for Clinicians on the Appropriate Dosage
Reduction or Discontinuation of Long-Term Opioid Analgesics
provides advice to clinicians who are contemplating or
initiating a reduction in opioid dosage or discontinuation
of long-term opioid therapy for chronic pain. In each case
the clinician should review the risks and benets of the
current therapy with the patient, and decide if tapering is
appropriate based on individual circumstances.
After increasing every year for more than a decade, annual
opioid prescriptions in the United States peaked at 255 million in
2012 and then decreased to 191 million in 2017.
i
More judicious
opioid analgesic prescribing can benet individual patients as
well as public health when opioid analgesic use is limited to
situations where benets of opioids are likely to outweigh risks.
At the same time opioid analgesic prescribing changes, such
as dose escalation, dose reduction or discontinuation of long-
term opioid analgesics, have potential to harm or put patients at
risk if not made in a thoughtful, deliberative, collaborative, and
measured manner.
Risks of rapid opioid taper
• Opioids should not be tapered rapidly or discontinued
suddenly due to the risks of signicant opioid withdrawal.
• Risks of rapid tapering or sudden discontinuation of opioids
in physically dependent
ii
patients include acute withdrawal
symptoms, exacerbation of pain, serious psychological
distress, and thoughts of suicide.
1
Patients may seek other
sources of opioids, potentially including illicit opioids, as a
way to treat their pain or withdrawal symptoms.
1
• Unless there are indications of a life-threatening issue,
such as warning signs of impending overdose, HHS
does not recommend abrupt opioid dose reduction or
discontinuation.
Whether or not opioids are tapered, safe and eective nonopioid
treatments should be integrated into patients’ pain management
plans based on an individualized assessment of benets and risks
considering the patient’s diagnosis, circumstances, and unique
needs.
2,3,4
Coordination across the health care team is critical.
Clinicians have a responsibility to provide or arrange for
coordinated management of patients’ pain and opioid-related
problems, and they should never abandon patients.
2
More
specic guidance follows, compiled from published guidelines
(the CDC Guideline for Prescribing Opioids for Chronic Pain
2
and the VA/DoD Clinical Practice Guideline for Opioid Therapy
for Chronic Pain
3
) and from practices endorsed in the peer-
reviewed literature.
Consider
iii
tapering to a reduced opioid dosage, or
tapering and discontinuing opioid therapy, when
• Pain improves
3
• The patient requests dosage reduction or discontinuation
2,3,5
• Pain and function are not meaningfully improved
2,3,5
• The patient is receiving higher opioid doses without evidence
of benet from the higher dose
2,3
• The patient has current evidence of opioid misuse
3,5
• The patient experiences side eects
iv
that diminish quality of
life or impair function
3
• The patient experiences an overdose or other serious event (e.g.,
hospitalization, injury),
2,5
or has warning signs for an impending
event such as confusion, sedation, or slurred speech
2,6
• The patient is receiving medications (e.g., benzodiazepines) or
has medical conditions (e.g., lung disease, sleep apnea, liver
disease, kidney disease, fall risk, advanced age) that increase
risk for adverse outcomes
3,5
• The patient has been treated with opioids for a prolonged
period (e.g., years), and current benet-harm balance is unclear
i
https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html
ii
Physical dependence occurs with daily, around-the-clock use of opioids for more than a few days and means that the body has adapted to the drug,
requiring more of it to achieve a certain eect (tolerance). Patients with physical dependence will experience physical and/or psychological symptoms
if drug use is abruptly ceased (withdrawal).
iii
Additional tools to help weigh decisions about continuing opioid therapy are available: Assessing Benets and Harms of Opioid Therapy, Pain
Management Opioid Taper Decision Tool, and Tapering Opioids for Chronic Pain.
iv
e.g., drowsiness, constipation, depressed cognition
2 HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics
Important considerations prior to deciding to taper
Overall, following voluntary reduction of long-term opioid
dosages, many patients report improvements in function,
sleep, anxiety, and mood without worsening pain or even with
decreased pain levels.
4,7,8,9,10,11
Other patients report increased
pain, insomnia, anxiety, and depression.
4,7,9,12
The duration of
increased pain related to hyperalgesia or opioid withdrawal
is unpredictable and may be prolonged in some patients.
12
Decisions to continue or reduce opioids for pain should
be based on individual patient needs.
2,13
Consider whether
opioids continue to meet treatment goals, whether opioids are
exposing the patient to an increased risk for serious adverse
events or opioid use disorder, and whether benets continue
to outweigh risks of opioids.
2,13
• Avoid insisting on opioid tapering or discontinuation
when opioid use may be warranted (e.g., treatment of
cancer pain, pain at the end of life, or other circumstances
in which benets outweigh risks of opioid therapy). The
CDC Guideline for Prescribing Opioids for Chronic Pain does not
recommend opioid discontinuation when benets of opioids
outweigh risks.
2,4,13
• Avoid misinterpreting cautionary dosage thresholds
as mandates for dose reduction.
4
While, for example,
the CDC Guideline recommends avoiding or carefully
justifying increasing dosages above 90 MME/day, it does
not recommend abruptly reducing opioids from higher
dosages.
2,4
Consider individual patient situations.
• Some patients using both benzodiazepines and opioids
may require tapering one or both medications to reduce
risk for respiratory depression. Tapering decisions and
plans need to be coordinated with prescribers of both
medications.
2
If benzodiazepines are tapered, they should
be tapered gradually
v
due to risks of benzodiazepine
withdrawal (anxiety, hallucinations, seizures, delirium
tremens, and, in rare cases, death).
2
• Avoid dismissing patients from care. This practice puts
patients at high risk and misses opportunities to provide
life-saving interventions, such as medication-assisted
treatment for opioid use disorder.
2,4,13
Ensure that patients
continue to receive coordinated care.
• There are serious risks to noncollaborative tapering
in physically dependent patients, including acute
withdrawal, pain exacerbation, anxiety, depression,
suicidal ideation, self-harm, ruptured trust, and patients
seeking opioids from high-risk sources.
1,14
Important steps prior to initiating a taper
• Commit to working with your patient to improve
function and decrease pain.
2,7
Use accessible, aordable
nonpharmacologic and nonopioid pharmacologic
treatments.
2,3,7
Integrating behavioral and nonopioid pain
therapies before and during a taper can help manage pain
10
and strengthen the therapeutic relationship.
• Depression, anxiety, and post-traumatic stress disorder
(PTSD) can be common in patients with painful
conditions, especially in patients receiving long-term
opioid therapy.
15
Depressive symptoms predict taper
dropout.
7,8
Treating comorbid mental disorders can
improve the likelihood of opioid tapering success.
• If your patient has serious mental illness, is at high suicide
risk, or has suicidal ideation, oer or arrange for consultation
with a behavioral health provider before initiating a taper.
3,5
• If a patient exhibits opioid misuse behavior or other
signs of opioid use disorder, assess for opioid use
disorder using DSM-5 criteria.
2,5
If criteria for opioid use
disorder are met (especially if moderate or severe), oer
or arrange for medication-assisted
vi
treatment.
2,3
• Access appropriate expertise if considering opioid tapering
or managing opioid use disorder during pregnancy. Opioid
withdrawal risks include spontaneous abortion and premature
labor. For pregnant women with opioid use disorder,
medication-assisted treatment is preferred over detoxication.
2
• Advise patients that there is an increased risk for overdose on
abrupt return to a previously prescribed higher dose.
2
Strongly
caution that it takes as little as a week to lose tolerance and
that there is a risk of overdose if they return to their original
dose.
2,3,5,6
Provide opioid overdose education and consider
oering naloxone.
2
Share decision-making with patients
• Discuss with patients their perceptions of risks, benets,
and adverse eects of continued opioid therapy, and
include patient concerns in taper planning. For patients at
higher risk of overdose based on opioid dosages, review
benets and risks of continued high-dose opioid therapy.
2,5
• If the current opioid regimen does not put the patient
at imminent risk, tapering does not need to occur
immediately.
4
Take time to obtain patient buy-in.
14
• For patients who agree to reduce opioid dosages, collaborate
with the patient on a tapering plan.
2
Tapering is more likely
to be successful when patients collaborate in the taper.
vii
Include patients in decisions, such as which medication will
be decreased rst and how quickly tapering will occur.
v
Example benzodiazepine tapers and clinician guidance are available at https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/
Benzodiazepine_Provider_AD_%20Risk_Discussion_Guide.pdf
vi
See SAMHSA’s TIP 63: Medications for Opioid Use Disorder, SAMHSA’s Buprenorphine Practitioner Locator, and SAMHSA’s Opioid Treatment Program Directory
vii
A recent systematic review found that when opioids were tapered with buy-in from patients who agreed to decrease dosage or discontinue therapy,
pain, function, and quality of life improved after opioid dose reduction.
10
HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics 3
Individualize the taper rate
• When opioid dosage is reduced, a taper slow enough to
minimize opioid withdrawal symptoms and signs
viii
should
be used.
2
Tapering plans should be individualized based
on patient goals and concerns.
2,3,5,6
• The longer the duration of previous opioid therapy, the
longer the taper may take. Common tapers involve dose
reduction of 5% to 20% every 4 weeks.
3,5
Slower tapers (e.g., 10% per month or slower)
are often better tolerated than more rapid tapers,
especially following opioid use for more than a year.
2
Longer intervals between dose reductions allow
patients to adjust to a new dose before the next
reduction.
5
Tapers can be completed over several
months to years depending on the opioid dose. See
“slower taper” example here.
Faster tapers can be appropriate for some patients.
A decrease of 10% of the original dose per week or
slower (until 30% of the original dose is reached,
followed by a weekly decrease of 10% of the
remaining dose) is less likely to trigger withdrawal
7
and can be successful for some patients, particularly
after opioid use for weeks to months rather than
years. See “faster taper” example here.
• At times, tapers might have to be paused and restarted
again when the patient is ready.
2
Pauses may allow the
patient time to acquire new skills for management of pain
and emotional distress, introduction of new medications,
or initiation of other treatments, while allowing for
physical adjustment to a new dosage.
3,5
• Tapers may be considered successful as long as the
patient is making progress, however slowly, towards a
goal of reaching a safer dose,
2
or if the dose is reduced to
the minimal dose needed.
• Once the smallest available dose is reached, the interval
between doses can be extended
2,5,7
Opioids may be
stopped, if appropriate, when taken less often than once a
day.
2,7
See “example tapers for opioids” here.
• More rapid tapers (e.g., over 2-3 weeks
16
) might be needed
for patient safety when the risks of continuing the opioid
outweigh the risks of a rapid taper (e.g., in the case of a
severe adverse event such as overdose).
• Ultrarapid detoxication under anesthesia is associated
with substantial risks and should not be used.
2
Opioid Tapering Flowchart
Assess benets and risks of continuing opioids at current dose
Benets outweigh risks
Document risk-benet assessment
Re-evaluate benets and risks quarterly
Risks outweigh benets
Discuss, educate, oer taper, start slow taper when ready
Able to taper down until benets outweigh risks
Re-evaluate benets and risks quarterly
Not able to taper down until benets outweigh risks
Meets criteria for opioid use disorder (OUD)
Transition to medication for OUD
(DATA waiver required for buprenorphine)
Does not meet criteria for OUD
Slow taper or transition to buprenorphine for pain
(DATA waiver not required)
Re-evaluate benets and risks quarterly
Adapted from Oregon Pain Guidance. Tapering – Guidance & Tools. Available at https://www.oregonpainguidance.org/guideline/tapering/.
4 HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics
DSM5 Opioid Use Disorder
A problematic pattern of opioid use leading to clinically
signicant impairment or distress, as manifested by at least 2
of the following, occurring within a 12-month period:
1. Opioids are often taken in larger amounts or over a longer
period than was intended.
2. There is a persistent desire or unsuccessful eorts to cut
down or control opioid use.
3. A great deal of time is spent in activities necessary to
obtain, use, or recover from the eects of opioids.
4. Craving, or a strong desire or urge to use opioids.
5. Recurrent opioid use resulting in a failure to fulll major
role obligations at work, school, or home.
6. Continued opioid use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the eects of opioids.
7. Important social, occupational, or recreational activities are
given up or reduced because of opioid use.
8. Recurrent opioid use in situations in which it is physically
hazardous.
9. Continued opioid use is continued despite knowledge of
having a persistent or recurrent physical or psychological
problem that is likely to have been caused or exacerbated
by the substance.
10. Tolerance, as dened by either of the following:
a. A need for markedly increased amounts of opioids to
achieve intoxication or desired eect, or
b. Markedly diminished eect with continued use of the
same amount of an opioid.
Note: This criterion is not considered to be met for those
taking opioids solely under appropriate medical supervision.
11. Withdrawal, as manifested by either of the following:
a. The characteristic opioid withdrawal syndrome, or
b. Opioids (or a closely related) substance is taken to
relieve or avoid withdrawal symptoms.
Note: This criterion is not considered to be met for those taking
opioids solely under appropriate medical supervision.
Mild: Presence of 2-3 symptoms
Moderate: Presence of 4-5 symptoms
Severe: Presence of 6 or more symptoms
Reprinted with permission from the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition, (Copyright ©2013). American Psychiatric
Association. All Rights Reserved.
Treat symptoms of opioid withdrawal
• If tapering is done gradually, withdrawal symptoms
should be minimized and manageable.
• Expectation management is an important aspect of
counseling patients through withdrawal.
• Signicant opioid withdrawal symptoms may indicate a
need to pause or slow the taper rate.
• Onset of withdrawal symptoms depends on the duration
of action of the opioid medication used by the patient.
Symptoms can begin as early as a few hours after the last
medication dose or as long as a few days, depending on
the duration of action.
7
Early withdrawal symptoms (e.g.,
anxiety, restlessness, sweating, yawning, muscle aches,
diarrhea and cramping
viii
) usually resolve after 5-10 days
but can take longer.
5
• Some symptoms (e.g., dysphoria, insomnia, irritability) can
take weeks to months to resolve.
• Short-term oral medications can help manage withdrawal
symptoms, especially when prescribing faster tapers.
5
These include alpha-2 agonists
ix
for the management of
autonomic signs and symptoms (sweating, tachycardia),
and symptomatic medications
x
for muscle aches, insomnia,
nausea, abdominal cramping, or diarrhea.
5
Provide behavioral health support
• Make sure patients receive appropriate psychosocial
support.
2,3,6,11
Ask how you can support the patient.
5
• Acknowledge patient fears about tapering.
5
While motives
for tapering vary widely, fear is a common theme. Many
patients fear stigma, withdrawal symptoms, pain, and/or
abandonment.
13,18
• Tell patients “I know you can do this” or “I’ll stick by you through
this.” Make yourself or a team member available to the patient to
provide support, if needed.
3,6
Let patients know that while pain
might get worse at rst, many people have improved function
without worse pain after tapering opioids.
7,8,9,10,11
• Follow up frequently. Successful tapering studies have used
at least weekly follow up.
10
• Watch closely for signs of anxiety, depression, suicidal
ideation, and opioid use disorder and oer support or
referral as needed.
2,3,6
Collaborate with mental health
providers and with other specialists as needed to optimize
psychosocial support for anxiety related to the taper.
2
viii
Acute opioid withdrawal symptoms and signs include drug craving, anxiety, restlessness, insomnia, abdominal pain or cramps, nausea, vomiting,
diarrhea, anorexia, sweating, dilated pupils, tremor, tachycardia, piloerection, hypertension, dizziness, hot ashes, shivering, muscle or joint aches,
runny nose, sneezing, tearing, yawning, and dysphoria.
7
Worsening of pain is a frequent symptom of withdrawal that may be prolonged but tends to
diminish over time for many patients.
7
ix
Alpha-2 agonists clonidine and lofexidine are more eective than placebo in ameliorating opioid withdrawal.
17
There is not similar research in patients
tapering from long-term opioid treatment for pain.
7
Lofexidine has an FDA-approved indication for use up to 14 days for “mitigation of opioid
withdrawal symptoms to facilitate abrupt opioid discontinuation in adults.”
x
NSAIDs, acetaminophen, or topical menthol/methylsalicilate for muscle aches; trazodone for sleep disturbance; prochlorperazine, promethazine, or
ondansetron for nausea; dicyclomine for abdominal cramping; and loperamide or bismuth subsalicylate for diarrhea.
5
HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics 5
Special populations
• If patients experience unanticipated challenges to
tapering, such as inability to make progress despite
intention to taper or opioid-related harm, assess for
opioid use disorder using DSM-5 criteria.
2
If patients
meet criteria for opioid use disorder (especially if
moderate or severe), oer or arrange medication-
assisted treatment.
2,3
• If patients on high opioid dosages are unable to
taper despite worsening pain and/or function with
opioids, whether or not opioid use disorder criteria
are met, consider transitioning to buprenorphine.
4,12
Buprenorphine is a partial opioid agonist that can treat
pain as well as opioid use disorder,
19
and has other
properties that may be helpful,
3
including less opioid-
induced hyperalgesia
12
and easier withdrawal than full
mu-agonist opioids,
3
and less respiratory depression
than other long-acting opioids.
20
Buprenorphine can
then be continued or tapered gradually.
12
Transitioning
from full-agonist opioids requires attention to timing
of the initial buprenorphine dose to avoid precipitating
withdrawal.
xi
Consultation with a clinician experienced in use of
buprenorphine is warranted if unfamiliar with its
initiation. SAMHSA’s Providers Clinical Support System
oers training and technical assistance as well as
mentors to assist those who need to taper opioids and
may have additional questions.
• Closely monitor patients who are unable or unwilling
to taper and who continue on high-dose or otherwise
high-risk opioid regimens. Mitigate overdose risk
(e.g., provide overdose education and naloxone).
Use periodic and strategic motivational questions
and statements to encourage movement toward
appropriate therapeutic changes.
14
xi
To avoid precipitating protracted withdrawal from full agonist
opioids when starting buprenorphine, patients need to be in mild
to moderate withdrawal (including Clinical Opioid Withdrawal Score
(COWS) objective signs) before the rst buprenorphine dose.
12
To do this, wait at least 8 to 12 hours after the last dose of short-
acting full agonist opioids before the rst dose of buprenorphine.
12
Buprenorphine buccal lm (Belbuca) and buprenorphine
transdermal system (Butrans) have FDA-approved indications for
“the management of pain severe enough to require daily, around-
the-clock, long-term opioid treatment and for which alternative
treatment options are inadequate.” The full Belbuca prescribing
information and the full Butrans prescribing information include
instructions for conversion from full agonist opioids. More time
should be allowed before starting buprenorphine following the last
dose of long-acting full agonist opioids (e.g., at least 36 hours after
last methadone dose); in addition, transition from methadone to
buprenorphine is likely to be better tolerated after methadone is
gradually tapered to 40mg per day or less.
12
Because the duration
of action for analgesia is much shorter than the duration of action
for suppression of opioid withdrawal,
21
“split dosing” (e.g., 8mg
sublingual tablet twice a day) rather than once a day dosing is used
when buprenorphine is provided for pain management.
3,12
References
1. FDA identies harm reported from sudden discontinuation of opioid pain
medicines and requires label changes to guide prescribers on gradual,
individualized tapering. Available at https://www.fda.gov/Drugs/DrugSafety/
ucm635038.htm (accessed April 13, 2019)
2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for
Chronic Pain - United States, 2016. MMWR Recomm Rep. 2016 Mar 18;65(1):1-49.
3. Department of Veterans Aairs. Department of Defense. VA/DoD Clinical
Practice Guideline for Opioid Therapy for Chronic Pain. Version 3.0 – 2017.
Available at https://www.healthquality.va.gov/guidelines/Pain/cot/
VADoDOTCPG022717.pdf
4. KroenkeK, Alford DP, Argo C, et al. Challenges with Implementing
the Centers for Disease Control and Prevention Opioid Guideline:
AConsensusPanelReport. Pain Med. 2019 Apr 1;20(4):724-735.
5. Veterans Health Administration PBM Academic Detailing Service. Pain
Management Opioid Taper Decision Tool_A VA Clinician’s Guide. Available at
https://www.pbm.va.gov/AcademicDetailingService/Documents/Pain_Opioid_
Taper_Tool_IB_10_939_P96820.pdf (accessed September 17, 2019)
6. Pocket Guide: Tapering Opioids for Chronic Pain – CDC. Available at https://
www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf
(accessed March 27, 2019)
7. Berna C, Kulich RJ, Rathmell JP. Tapering Long-term Opioid Therapy in Chronic
Noncancer Pain: Evidence and Recommendations for Everyday Practice. Mayo
Clin Proc. 2015 Jun;90(6):828-42.
8. Darnall BD, Ziadni MS, Stieg RL, Mackey IG, Kao MC, Flood P. Patient-Centered
Prescription Opioid Tapering in Community Outpatients With Chronic Pain.
JAMA Intern Med. 2018 May 1;178(5):707-708.
9. GoeslingJ, DeJonckheere M, Pierce J, Williams DA, Brummett CM,
Hassett AL, Clauw DJ. Opioidcessation and chronic pain: perspectives of
formeropioidusers. Pain. 2019 May;160(5):1131-1145.
10. Frank JW, Lovejoy TI, Becker WC, et al. Patient Outcomes in Dose Reduction or
Discontinuation of Long-Term Opioid Therapy: A Systematic Review. Ann Intern
Med. 2017 Aug 1;167(3):181-191.
11. Sullivan MD, Turner JA, DiLodovico C et al. Prescription Opioid Taper Support
for Outpatients with Chronic Pain: A Randomized Controlled Trial. J Pain. 2017
Mar;18(3):308-318.
12. Manhapra A, Arias AJ, Ballantyne JC. The conundrum of opioid tapering
in long-term opioid therapy for chronic pain: A commentary. Subst Abus.
2018;39(2):152-161.
13. U.S. Department of Health and Human Services. Pain Management Best
Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and
Recommendations. May 2019. Available at https://www.hhs.gov/ash/advisory-
committees/pain/index.html.
14. Dowell D, Haegerich TM. Changing the Conversation About Opioid Tapering.
Ann Intern Med. 2017 Aug 1;167(3):208-209.
15. Sullivan MD. Depression Eects on Long-term Prescription Opioid Use, Abuse,
and Addiction. Clin J Pain. 2018 Sep;34(9):878-884.
16. Washington State Agency Medical Directors’ Group. AMDG 2015 interagency
guideline on prescribing opioids for pain. Olympia, WA: Washington State Agency
Medical Directors’ Group; 2015. Available at http://www.agencymeddirectors.
wa.gov/Files/2015AMDGOpioidGuideline.pdf (accessed September 17, 2019)
17. Gowing L, Farrell M, Ali R, White JM. Alpha2-adrenergic agonists for the
management of opioid withdrawal. Cochrane Database Syst Rev. 2016
May 3;(5):CD002024. Available at https://www.cochranelibrary.com/cdsr/
doi/10.1002/14651858.CD002024.pub5/full (accessed September 17, 2019)
18. Henry, SG, Paterniti, DA, Feng, B, et al. Patients’ experience with opioid tapering:
A conceptual model with recommentations for clinicians. J Pain. 2019; 20(2):
181-191.
19. Pade PA, Homan RM, Geppert CM. Prescription opioid abuse, chronic pain,
and primary care: a Co-occurring Disorders Clinic in the chronic disease model.
J Subst Abuse Treat. 2012 Dec;43(4):446-50.
20. Dahan A, Yassen A, Romberg R, Sarton E, Teppema L, Olofsen E, Danhof M.
Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br
J Anaesth. 2006;96(5):627. Epub 2006 Mar 17.
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6 HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics
The U.S. Department of Health and Human Services Working Group on Patient-Centered
Reduction or Discontinuation of Long-term Opioid Analgesics, chartered under the
Assistant Secretary for Health ADM Brett Giroir, developed this guide:
Co-chairs
Deborah Dowell, MD, MPH
CAPT, US Public Health Service
Centers for Disease Control and Prevention
Christopher Jones, PharmD, DrPH
CAPT, US Public Health Service
Centers for Disease Control and Prevention
Wilson Compton, MD, MPE
National Institutes of Health
Workgroup members
Elisabeth Kato, MD, MRP
Agency for Healthcare Research and Quality
Joel Dubenitz, PhD
Oce of The Assistant Secretary for Planning and Evaluation
Shari Ling, MD
Centers for Medicare and Medicaid Services
Daniel Foster, DO, MS, MPH
Food and Drug Administration
Sharon Hertz, MD
Food and Drug Administration
Marta Sokolowska, PhD
Food and Drug Administration
Judith Steinberg, MD, MPH
Health Resources and Services Administration
Meena Vythilingam, MD
CAPT, US Public Health Service
Oce of the Assistant Secretary for Health
Thomas Clarke, PhD
Substance Abuse and Mental Health Services Administration
Brett P. Giroir, M.D.
ADM, US Public Health Service
Assistant Secretary for Health
October 2019
U.S. Department of Health and Human Services
