Opioid wean

[paindoc007]

Hey guys. Im considering leaving practice and going elsewhere. Question is, what’s the best way to go about with weaning patients off of meds? I don’t believe I can get these folks plugged in with someone willing to take over the rx.

Max I do is 40 MME (Oxy 10 4x/day) so luckily nothing too crazy. Do I need to wean those over the course of a few months? Is it ok for people on lighter doses (norco 5 bid-tid) to just instruct them on a self wean? Thoughts? Thanks

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[DODOCSS]

40 MME (Oxy 10 4x/day)???

 

[paindoc007]

40 MME (Oxy 10 4x/day)???

Absolutely max, a few patients yeah. Not many

 

[mdo1738]

Absolutely max, a few patients yeah. Not many

I think his numerous question marks may have been because that's 60 OME

 

[kstarm]

Yes most would consider OXY 40mg=60MME. There is no specific science with this, but in general people on opioids less than week or on less than 20mme can stop opioids with minimal withdrawal. For people on bid, tid, or qid dosing I would just drop by one dose per week until off. That would have everyone off in a month. You could give a little clonidine if you want to help cover withdrawal symptoms. More important would be to be available and help them through it when/if it gets tough.

 

[Agast]

Switch the oxycodone QID to hydrocodone QID and you’ve already weaned 33%. It is an opioid rotation for tolerance and the patient will tolerate it better because they are not sacrificing the frequency and the dose reads “the same” to them psychologically.

 

[Ferrismonk]

CDC says wean approximately 10% week if long time use, so that's roughly over 2-3 months if you go that slow. If 4x tabs per day and you have a firm date when you're leaving, I think dropping 0.5-1 tab per week equivalent is reasonable. If you have some time, give your patients a chance to find someone else prior to initiating wean just in case.

 

[GoBeers]

Hey guys. Im considering leaving practice and going elsewhere. Question is, what’s the best way to go about with weaning patients off of meds? I don’t believe I can get these folks plugged in with someone willing to take over the rx.

Max I do is 40 MME (Oxy 10 4x/day) so luckily nothing too crazy. Do I need to wean those over the course of a few months? Is it ok for people on lighter doses (norco 5 bid-tid) to just instruct them on a self wean? Thoughts? Thanks

very thoughtful of you.

local pain doc finally retired here and gave no assistance or guidance for his high dose opioid patients.

 

[Ducttape]

how long before you leave?

i would suggest that you send a note to as many of the primary care physicians that you are retiring and their patients are on opioids, and ask if they would be willing to talk to their patients about assuming care of these medications.

let the patient know that you are sending this message, and if the PCP is unwilling to prescribe, you have the duty to a safe wean, if the patient cannot find another prescriber in the time frame before you leave. give them the date where you will no longer be able to fill any further prescriptions (like 1-2 weeks before you close shop).

those under 20 MED per day - tell them they can continue to take their prn med without concern for withdrawal and stop when they run out.

those above - decrease by 1 pill per week is most reasonable.

 

[deleted875186]

Another reason to never do higher dose opioids. Someone on QID oxycodone 10mg I would suggest decreasing by one pill daily every month, start 3-4 months out, inform them that your going to have to wean them unless they’re PCP picks it up or they find another clinic to prescribe.

I like the idea of rotating to Vicodin, less potent, then wean them down.

 

[lobelsteve]

Another reason to never do higher dose opioids. Someone on QID oxycodone 10mg I would suggest decreasing by one pill daily every month, start 3-4 months out, inform them that your going to have to wean them unless they’re PCP picks it up or they find another clinic to prescribe.

I like the idea of rotating to Vicodin, less potent, then wean them down.

Maybe 1 pill per week. Monthly? Why.

28 pills last week. 21 this week. 14 next week. 7 the following.