Domain 3: When and how to taper opioids in patients with chronic pain taking cannabinoids
The third domain discussed questions around when and how to taper opioids in patients being administered opioids and cannabinoids. The key consensus findings are:
1) Depending on the patient, begin the opioid taper when any of the following criteria are met: the patient has an improvement in pain/function, the cannabinoid dose has been optimized, or the patient begins to seek less “as needed” medication. Importantly, it was recommended to not begin tapering opioids at cannabinoid initiation or a specific cannabinoid dose.
2) When initiating the opioid taper, a gradual opioid dose reduction of 5–10% of the MED every one to four weeks was agreed upon. The timeline for the frequency of dose reduction is broad to allow for patient tailoring, and is similar to previously published opioid tapering recommendations.1,3 More recently, the U.S. Department of Health & Human Services have published opioid-tapering guidelines.70,71 These guidelines do not provide specific MED targets and encourage a highly individualized opioid tapering approach and collaborative shared decision-making with the patient. Indeed, there may be patients who could benefit from a 20%–50% rapid taper after titrating to an effective cannabinoid dose, depending on their objectives and needs.