Patients who may have a physical dependence on opioids should avoid abruptly stopping the use of oxycodone and acetaminophen tablets, as this can lead to suicide, uncontrolled pain, and severe withdrawal symptoms. Opioids and other substances, like heroin, can be utilized by patients to manage pain or alleviate withdrawal symptoms. However, it is important to note that the misuse of these drugs for the purpose of seeking a high can be mistaken for efforts to find alternative sources of opioid pain relievers, which are also linked to sudden discontinuation.
Referring patients with complex co-morbidities of substance use and pain disorders to a specialist may provide benefits. When suspected substance use disorders are being discontinued or when evaluating and treating the patient for the treatment of substance use disorder, referrals for evaluation and treatment of substance use disorder or for the patient to be treated and evaluated should be made. It is important to agree on a realistic and clear plan for follow-up, schedule appropriate tapering, and ensure ongoing care for both the provider and the patient. Various factors should be considered, including the patient’s attributes, psychological and physical well-being, the type and duration of pain being treated, and the dose of acetaminophen and oxycodone tablets the patient has been taking. When a decision has been made to discontinue opioid therapy or decrease the dose in an opioid-dependent patient taking acetaminophen and oxycodone tablets, it should be considered.
There are no standard schedules for tapering opioids that are suitable for all patients. Good clinical practice dictates that a patient-specific tapering plan should be implemented, gradually reducing the dose of the opioid. This is especially important for patients who are physically dependent on acetaminophen and oxycodone tablets and who have been taking opioids for shorter periods of time, as they may experience more rapid withdrawal symptoms if the dose is lowered too quickly. For example, a tapering schedule could involve reducing the daily total dose by no more than 25% every 2 to 4 weeks, using small increments to initiate the taper.
Patients should be monitored for changes in mood, emergence of suicidal thoughts, or use of alternative substances. If withdrawal symptoms occur, it is recommended to proceed with a slower taper and then increase the dose of the opioid analgesic to the previous level. Alternatively, the taper can be paused for a certain period of time. Various signs and symptoms may develop, such as increased blood pressure, respiratory rate, or heart rate, as well as vomiting, diarrhea, anorexia, nausea, insomnia, abdominal cramps, weakness, joint pain, backache, anxiety, and irritability. Common withdrawal symptoms include mydriasis, myalgia, chills, perspiration, yawning, rhinorrhea, lacrimation, and restlessness. It is important to manage pain and withdrawal symptoms and frequently reassess the patient in order to achieve a successful taper. Lower dosage strengths may be necessary to adequately treat the patient.
Prior to initiating a multimodal approach to pain management, including mental health support if needed, it may be beneficial to assist with the successful tapering of opioid analgesics in order to optimize the treatment of chronic pain. This is especially important for patients who have been treated with long-term opioid analgesics, particularly those who are managing pain while taking opioid analgesics.