The Curbsiders Internal Medicine Podcast #336 Updates in Addiction Medicine: Live from SGIM
May 23, 2022
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Avoid Routine Rapid Opioid Tapers
- Do not reflexively taper long-term opioids for stable patients without a clear reason.
- Use shared decision-making and avoid rapid large dose cuts to reduce overdose and mental-health risks.
Taper Slowly And Screen First
- Limit taper pace to small monthly decreases (roughly <10% per month) and tailor the plan to patient response.
- Screen for opioid use disorder and clarify the rationale before changing doses.
Keep Buprenorphine For Perioperative Pain
- Continue buprenorphine through surgery and manage acute pain with additional full opioid agonists as needed.
- Split buprenorphine dosing or give short-acting opioids on top while monitoring closely.