Relapse to opioid use is common after rapid opioid withdrawal. As a result, short-term taper of opioid agonist/partial agonist medications – such as methadone and buprenorphine/naloxone – are no longer recommended by recent clinical care guidelines for the management of opioid use disorder. Nonetheless, rapid tapers are still used in medically supervised withdrawal settings.
RAPID TAPER CASE SUMMARY:
A person with opioid use disorder was prescribed a rapid buprenorphine/naloxone taper in a medically supervised withdrawal facility; later had a subsequent opioid overdose and death after discharge. The full case description was just published in the Journal of Addiction medicine.
DISCUSSION:
The fatal outcome in this case study underscores the potential severe harms of rapid tapers. Given the increased overdose risk, tapers should be avoided and continuing care strategies – such as maintenance pharmacotherapy – should be started in medically supervised withdrawal settings.
Long-term opioids should be the first line of treatment. This simple measure can help prevent overdoses and deaths. Long term treatment outcomes will improve.
Source: Chang, D., Klimas, J., Wood, E., Fairbairn, N. (2017) A case of fatal overdose following inpatient detoxification: The problematic role of rapid opioid agonist tapers for opioid use disorder. (Online first Sept 19) J Addiction Medicine
https://www.ncbi.nlm.nih.gov/pubmed/28930773