There are many reasons to wish to reduce your opioid use. Opioid medications can cause serious side effects, such as constipation, hormonal imbalances, and cognitive slowing. Decreasing opioids is generally approached in the following speeds and methods:
There are many factors that influence these decisions, and they are made based on mutual patient-physician discussion and decision-making.
Generally, we target decreasing opioid milligram amounts by 10% per week. This typically allows the body to adjust to the change in dose and avoids any symptoms of withdrawal or withdrawal associated increased pain, also known as withdrawal-induced pain or WIP. If withdrawal symptoms are encountered, a decision can be made to use medications that treat, cover up, or reduce the symptoms of withdrawal. A slowing of the withdrawal timing may work as well.
Alternatively, you may choose to transition away from opioids over an intermediate time frame of weeks. This can be done starting with micro dosing of buprenorphine and continuing to increase the dose while the short-acting opioid dose is decreased. This can sometimes become necessary when there are insurance authorization or cost factors that make it necessary to change opioids. We can achieve this using a gradual transition so that withdrawal symptoms are avoided, and back-up medications can be prescribed to treat any withdrawal symptoms that arise.
When opioids have become misused and there is a loss of control of dosing, especially when combined with other sedating medications such as benzodiazepines or alcohol, it may be necessary to make a rapid transition from the currently used opioids. In these cases, a transition to buprenorphine to both treat pain and avoid withdrawal symptoms, while making a change from more dangerous opioids may be the best option. This can often be done successfully and with very minimal withdrawal symptoms. Other types of medications can be prescribed when needed to help treat any withdrawal symptoms that may arise.
Circumstances may develop where opioids may become an overwhelming problem for some people. When opioid misuse takes control of your life, there is a way to come off the opioids quickly and safely by starting with higher dose buprenorphine. This way, withdrawal symptoms are avoided, and opioid cravings are controlled. In these circumstances, you will be asked to go into a minor withdrawal state by the morning of treatment initiation, then buprenorphine will be dosed so these withdrawal symptoms are stopped. The medication dose is titrated, and you may stay on buprenorphine for an indefinite period of time. This will be combined with attention to psychological treatment and social support networks to help ensure your success.
Opioids can significantly impact your quality of life, and when the risks of opioids outweigh the benefits, the providers at the Denver Spine and Pain Institute are equipped to help you make this transition as smoothly as possible. Our goal is to help you get back to the life you love.
We have designed our exclusive Connected Care Approach™ to get you back to enjoying your life faster. This approach involves:
Please contact us today to schedule an appointment. The Denver Spine and Pain Institute serves patients in Denver and the surrounding areas of Colorado.
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