Does your patient need an opioid exit strategy?

CONTROL
THESE SYMPTOMS

to help her abruptly discontinue opioids

LUCEMYRA® is the first and only FDA-approved, non-opioid, non-addictive treatment for relief of multiple symptoms of opioid withdrawal to facilitate abrupt opioid discontinuation in adults.1 Learn more

Learn more about Opioid Withdrawal Syndrome (OWS) and how it can affect your patients

Joseph Pergolizzi, MD
Pain Specialist

When the time comes for opioid discontinuation, do you have an exit strategy for your patients?

Planning an exit strategy helps ensure that patients do not continue opioid therapy for longer than necessary

After only 5 DAYS of use

Physical dependence to opioids occurs2

After 1 MONTH of use

30% of patients still use opioids 1 year later2

Your strategy for opioid discontinuation will depend on your individual patient’s situation

Discontinuation plan agreed upon with patient from

THE START OF TREATMENT

  • Patients who are about to begin a short-term course of opioid therapy of 5 days or more

OR

Discontinuation plan based on

PATIENT NEED

  • Patients on short-term opioid therapy (due to acute and/or post-surgical pain)
  • Chronic pain patients on long-term opioid therapy who are ready to discontinue and are willing to manage residual pain with non-opioid therapies, such as acetaminophen

The CDC recommends a conservative approach when treating patients with opioids3

    • The CDC recommends clinicians evaluate the benefits and harms of continued opioid therapy with patients every 3 months or more frequently
    • If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other non-opioid therapies

Withdrawal symptoms can be a barrier for patients considering opioid discontinuation

Avoidance of withdrawal is a driver of continued opioid use4

      • According to a survey of patients originally prescribed opioids for chronic pain, more than half (57%) reported that avoiding withdrawal symptoms was their primary reason for current use, rather than for pain relief (23%), or wanting to “get high” (14%)
  • Symptoms of opioid withdrawal, sometimes known as Opioid Withdrawal Syndrome (OWS), are associated with both psychological distress and physical discomfort5

    Symptoms of opioid withdrawal include6:

    • Aches and pains
    • Stomach cramps
    • Feeling sick
    • Muscle spasms/twitching
    • Insomnia/problems sleeping
    • Feeling of coldness/chills
    • Muscular tension
    • Heart pounding
    • Runny eyes
    • Yawning

    Patients who regularly take opioids—even under medical supervision—can become physically dependent and be at risk for OWS

    References:

    1. LUCEMYRA® (lofexidine) [Prescribing Information]. Louisville, KY: US WorldMeds, LLC; 2018.
    2. Shah A, Hayes CJ, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use – United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(10):265-269.
    3. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. JAMA. 2016;315:1624-1645.
    4. Weiss RD, Potter JS, Griffith ML, et al. Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain. J Subst Abuse Treat. 2014;47(2):140-145.
    5. Shigakova F. Clinical manifestations of the opiate withdrawal syndrome. Int J Biomed. 2015;5(3): 151-154.
    6. Vernon MK, Reinders S, Mannix S, et al. Psychometric evaluation of the 10-item Short Opiate Withdrawal Scale-Gossop (SOWS-Gossop) in patients undergoing opioid detoxification. Addict Behav. 2016;60:109-116.
    7. Volkow ND, McLellan AT. Opioid Abuse in Chronic Pain–Misconceptions and Mitigation Strategies. N Engl J Med. 2016;374(13):1253-1263.
    8. National Institute on Drug Abuse. Treatment Approaches for Drug Addiction. https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction. Revised January 2018. Accessed January 8, 2019.
    9. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002;1(1):13-20.