New Reference Tool Provides Evidence-based Guidance on Opioid Tapering

Share Article

Healthesystems clinicians assembled a valuable resource for workers’ compensation payers to share with prescribers who are treating patients for chronic pain with opioid therapy.

Gradually reducing a patient’s morphine equivalent dose with a tapering protocol can open up the possibility of an injured worker discontinuing opioid therapy and returning to work and a productive lifestyle.

Implementation of an aggressive opioid management strategy that includes opioid dose tapering can minimize risks to injured workers and workers’ compensation claims organizations. Long-term opioid therapy carries significant risks and can lead to complex, escalating and expensive medication regimens that carry their own risks — and in many cases, prevent patients from returning to work. When the high number of fatal overdoses involving prescription opioids is considered, the need for opioid tapering becomes even more important. In 2010, almost 17,000 such deaths were recorded.

Gradually reducing a patient’s morphine equivalent dose (MED) with a tapering protocol can open up the possibility of an injured worker discontinuing opioid therapy and returning to work and a productive lifestyle. The current issue of the RxInformer clinical journal published by workers’ compensation PBM Healthesystems provides a comprehensive reference on opioid dose tapering suitable for claims organizations to share with prescribers. The article, “Opioids: A Guide to Tapering and Discontinuation,” summarizes current evidence-based tapering guidelines and:

  •     identifies steps to take before beginning a tapering process
  •     characterizes patients who may be appropriate for tapering
  •     lists withdrawal symptoms that may need to be managed
  •     identifies opportunities for referrals to other providers for adjunctive therapies

Payers may need to adjust current opioid management policies to include alternative therapies to help injured workers taper off opioid therapy. According to Robert Goldberg, MD, FACOEM, an occupational medicine specialist and chief medical officer at Healthesystems, “Alternative therapies such as cognitive behavior therapy can promote successful dose tapering when used as an adjunct to pharmacologic therapies. Referral to a mental health professional for cognitive behavior therapy can teach coping skills and reduce the anxiety that often accompanies the tapering process.”

Most patients can taper off opioids. Ideal candidates are:

  •     Patients taking high doses of opioids, regardless of whether they are long-acting or immediate-release formulations. Depending on the guideline followed, high doses refers to daily morphine equivalent dose (MED) over 50-120.
  •     Patients who show no improvement in functional gains despite continued therapy.
  •     Patients whose pain has increased or shows no modification despite dose increases.

RxInformer is a trusted source of clinical information and guidance on how best to plan for the challenges that lay ahead in workers’ compensation. The semi-annual publication provides insights across a broad spectrum of current and emerging industry trends. Key highlights of the spring 2014 issue include articles on:

  •     Conservative therapies that can prevent chronic opioid use.
  •     Neuroremodeling and the management of chronic pain.
  •     Emerging impacts of specialty pharmacy on workers’ compensation.
  •     High performance strategies to manage costly prescription drugs.
  •     Risks to payers and patients when states legalize marijuana.

Request a copy of the issue at or download the e-zine app for iPad® on the App Store. The app offers an interactive experience and additional content in the form of animations and links to related information.

About Healthesystems
Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. The company's comprehensive product portfolio includes a leading pharmacy benefit management (PBM) program, expert clinical review services, and a revolutionary ancillary benefits management (ABM) solution for prospectively managing ancillary medical services such as durable medical equipment (DME), home health, transportation and translation services. By leveraging innovation, powerful technology, clinical expertise and enhanced workflow automation tools, Healthesystems provides clients with flexible programs that reduce the total cost of medical care while improving the quality of care for injured workers. To learn more about Healthesystems visit

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Christine Duffy
Follow us on
Visit website