A recent publication by Health and Human Services (HSS) reports that opioid prescriptions in the US peaked at 255 million in 2012 and decreased to 191 million in 2017.

Prescribers—and the rest of the world—have become well aware of the unanticipated consequences of over-prescribing opioid pain medications. And although we know escalating the dose of a patient’s opioid pain medication can cause harm, so too, can quickly reducing a patient’s long-term opioid analgesics.

The Coleman Institute for Addiction Medicine has heard from many people who have been prescribed opioid pain medications for years. These medications include, but are not limited to: Oxycontin®, Opana®, Vicodin®, Roxicet®, morphine, fentanyl, and methadone. These people have been caught in the sometimes knee-jerk reaction as their doctors, interpreting the message to reduce long-term opioid analgesics, have tapered their patients too quickly or abruptly stopped prescribing.

The recent HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics lists the risks of rapid opioid taper:

  • Significant withdrawal
  • Exacerbation of pain
  • Serious psychological distress
  • Thoughts of suicide
  • Seeking illicit opioids as a way to treat their pain or withdrawal symptoms

Therefore, “unless there are indications of a life-threatening issue, such as warning signs of impending overdose, HHS does not recommend abrupt opioid dose reduction or discontinuation.”


They suggest several reasons for prescribers to continue tapering to a reduced opioid dosage or discontinuing altogether. These include the patient requesting their medications be reduced or discontinued, pain and function are not noticeably improved on the medication regimen, or the patient is receiving higher opioid doses without evidence of benefit from the increased amount.

These tend to be the main reasons patients seek the expertise of the Coleman Institute. While we also serve people who have become addicted to illegal or street drugs, a large percentage of our patients have been taking their medications exactly as prescribed (with maybe a few exceptions) and are ready to stop.

The Accelerated Opioid Detox using the Coleman Method helps people shorten the opioid detox process, but does so safely and comfortably. Each patient has their support person with them 24-7 so we are able to administer plenty of comfort medications as the opioids leave the body. Depending on the health and age of the patient and the amount and type of medication a patient has been taking, our Accelerated Opioid Detox can take anywhere from 3-8 days. The longer end of the range is for people desiring to get off long-acting opioids such as methadone or buprenorphine.

Importantly, this method, which Dr. Coleman has taught to providers around the country, is an outpatient procedure. Our patients are able to stay in the comfort of their homes, local hotel or Airbnb®, with their family during the entire detox procedure. Time in our office is spent reviewing medications, answering questions, and meeting with aftercare staff to plan out the next steps upon returning home.

If you are questioning your need to be on long-term opioid analgesics, please give our office a call. You may find, as most of our patients do, that your body is able to handle pain far better than you ever thought, or that the pain is actually far less than when opioids were first prescribed.

My colleagues and I look forward to working with you or answering any questions. You can reach us at 877-773-3869 for information on our programs.

Joan R. Shepherd, FNP