Risks with Sudden Discontinuation of Opioids

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Date: May 30, 2019
To: HPSJ Primary Care Providers, Specialists, and Pharmacies
From: HPSJ Medical Management Department
Subject: Risks with Sudden Discontinuation of Opioids
Business: Medi-Cal

The Department of Health Care Services (DHCS) wants all providers to be aware of the Food and Drug Administration (FDA) announcement of April 9, 2019 regarding risks of sudden discontinuation or decrease in dose of opioids.

The following safety warnings were added:

  • Serious withdrawal symptoms
  • Uncontrolled pain
  • Psychological distress
  • Suicide

What to do:

  • SAFELY decrease the dose in patients who are physically dependent on opioids
    • Agree on an appropriate tapering schedule and follow-up plan with each patient
    • Consider the dose, duration of treatment, type of pain being treated, and physical psychological attributes when developing the tapering schedule
    • Counsel the patient to contact a health care professional if they experience increased pain, withdrawal symptoms, changes in mood, or thoughts of suicide
    • Establish a multimodal approach to pain management (e.g., mental health support if needed) prior to tapering the opioid dose—especially for patients who have been treated for a long duration or are on high doses for chronic pain
    • Evaluate and treat or refer for substance use disorder as appropriate
  • To read the full safety announcement, which includes a summary of withdrawal symptoms, refer to the “FDA Drug Safety Communication: FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering” article found on the Drug Safety and Availability page of the FDA website [https://www.fda.gov/drugs/drug-safety-and-availability/fda-identifies-harm-reportedsudden-discontinuation-opioid-pain-medicines-and-requires-label-changes].

Health Plan of San Joaquin is dedicated to providing all members the best health care available in the most effective and efficient manner. You may contact our Customer Services Department with any questions or concerns, Monday through Friday 8:00 a.m. to 5:00 p.m. at (209) 942-6320.

Posted on May 30th, 2019 and last modified on May 31st, 2019.