Free Download
How to Taper Opioids Toolkit
Taking high doses of opioids may not provide good pain relief over a long period of time. The amount of
pain relief from opioids can become less at higher doses because of tolerance.

The Team for Innovation in Medication Safety (TIMES) developed new resources and tools for tapering opioids and disposing of them properly.

We encourage you to access this free toolkit and begin helping your patients taper opioids and dispose of them safely.
On-Demand Webinar
Opioid Tapering and Disposal Resources
Hear from a panel of healthcare providers, prescribers, and patients as they share tools and resources. You'll learn
  • key components of the CDC Guideline for Prescribing Opioids for Chronic Pain,
  • where to locate and access TIMES-developed resources for tapering opioids and safe drug disposal, and
  • how to apply TIMES-developed resources on tapering opioids, managing withdrawal symptoms, and safe drug disposal to specific patient scenarios.

The presentation slides are also available for download.
Frequently Asked Questions
Where do you dispose of used fentanyl patches?

FDA recommends disposing of used patches by folding them in half with the sticky sides together and then flushing them down a toilet. They should not be placed in the household trash where children or pets can find them.

So is it correct that when trying to streamline meds, and begin taper, you change the short acting medication into extended release, then taper the ER?

Yes, if feasible. The recommendation is to consolidate all short and long-acting opioids into a single extended release opioid before beginning the taper. 

These resources provide more information:

Murphy L, Babaei-Rad R, Buna D, et al. Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions. Can Pharm J (Ott). 2018;151(2):114-120. Published 2018 Feb 8. doi:10.1177/1715163518754918

NPS MedicineWise: Victoria State Government. Recommendations for Deprescribing or Tapering Opioids. Information for health professionals. May 2016.

Upon the death of a patient at your hospital, what do you do with the patient's home medication that was brought into the hospital, including controlled substances?

Legally, only the patient (or patient’s agent, in the event of a patient passing) may dispose of controlled substance medications. Thus legally, they would be returned to the patient’s family along with information for appropriate disposal.

Are Morphine Milligram Equivalents (MME) age-specific?

No. It is a standard conversion factor for equivalence across drug potency, and does not factor in patient specifics. For this reason, and given the broad range of individual response and level of tolerance, when dose-converting between opioids the end calculated dose should be reduced by the recommended percentage (10-50%, depending on the source) before being prescribed. I am not aware of an age-related difference in the MME cutoffs for increased risk of overdose and other adverse events (i.e. 50 MME and 90 MME).

Even though the MMEs are not age specific, it is important to note that the conversion factor from the CDC to calculate the MMEs includes these very specific words of caution: “These dose conversions are estimated and cannot account for all individual differences in genetics and pharmacokinetics.” Older patients have decreased renal function, liver function, and other variables that impact the pharmacodynamics and pharmacokinetics of medications. Such factors should be considered when addressing MMEs in the older person. This would also apply to any age person who might have different genetics or pharmacokinetics.
Questions? Please contact Amanda Ryan at .
This material was prepared by atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinated by Qsource for Tennessee, Kentucky, Indiana, Mississippi and Alabama under a contract with the CENTERS for MEDICARE & MEDICAID SERVICES (CMS), a federal agency of the U.S. Department of Health and Human Services. Content does not necessarily reflect CMS policy. 18.ASC32-ADE.08.015