Welcome to the High Dose Opioid Taper Initiative
The University of Michigan's High-dose Opioid Taper Initiative is a multidisciplinary quality assurance and patient safety effort. The project aims to address post-operative pain control before, during and after a patient's elective surgery. Based on daily opioid dosing, patients are identified as "high-risk" (for uncontrollable post-op pain, respiratory depression and other complications) in clinic by the surgical team - months before they ever come to the OR. This interval, along with cooperation between the patient's opioid prescriber and the UM anesthesia and surgical teams, allows for optimization of the patient's perioperative pain management. The safety of patients and success of the initiative depend upon reinforcement at every patient contact, including everyone from the PCP to the pre-op nurse. Most importantly, success rests in the hands of the opioid prescriber to help the patient achieve safety and comfort in the perioperative setting and beyond. This website provides a host of resources for opioid prescribers - we look forward to working with you to improve patient safety and care.
It is recommended that patients decreased the daily opioid dose to below 100mg PO Morphine equivalents prior to elective surgery. This tool will help determine a patient's equivalent dose and provide an approximate dose-reduction plan.
This flow chart provides a simple means to determine if a patient may benefit from tapering his or her opioid dosage prior to surgery.
This links to a host of detailed resources for clinicians and patients. The first resource on the page provides detailed guidelines to manage and taper opioid dosing; the remaining resources may also be helpful.
This link houses downloadable copies of the letters sent to both the patient and the primary opioid prescriber
Documents detailing effective use of the MAPS, including: registration instructions, report requests and an explanation of what a MAPS report provides and how it is used.
Perioperative pain control research remains in its infancy and participation in this initiative could lead to more evidence for future practice. This links to a collection of the relevant peer-reviewed literature to date.
Holding a conversation about decreasing dosing with a patient who is dependent on opioids can be very difficult. This link provides some suggestions to facilitate the conversation, as well as evidence-based justification for this initiative's importance.
If further assistance with pain medication management would be beneficial, consider using the University of Michigan Back and Pain Center as a referral resource.