Question special

Determining how best to taper an existing opioid regimen in a patient at risk for addiction poses a challenge for providers-in-training. Consensus guidelines are lacking. The CDC suggests down-titrating the total opioid dose by anywhere from 10% per week to 10% per month. The VA guidelines also give a wide range: between 5% and 20% every 4 weeks. What advice would you offer to a resident looking for a more concrete algorithm to follow in clinical practice? What strategies have you found effective to devise a tapering plan in collaboration with your patients, such that it is tailored to their individual needs?