Consider tapering to a reduced opioid dosage or tapering and discontinuing opioid therapy when your patient:

• requests dosage reduction
• does not have clinically meaningful improvement in pain and function (e.g., at least 30% improvement on the 3-item PEG scale)
• is on dosages ≥ 50 MME*/day without benefit or opioids are combined with benzodiazepines
• shows signs of substance use disorder (e.g. work or family problems related to opioid use, difficulty controlling use)
• experiences overdose or other serious adverse event
• shows early warning signs for overdose risk such as confusion, sedation, or slurred speech