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.