For patients admitted while taking chronic outpatient opioids, how do you decide whether to resume their baseline opioid regimen at discharge versus tapering or modifying therapy during hospitalization?

I'm not sure there's a single right answer here. My only recommendation is for patients who are on chronic outpatient opiates: please talk to their ambulatory clinician before making any significant changes. Their ambulatory doctor knows them over time and can give you advice regarding what's happen...

Drs. @Dr. First Last and @Dr. First Last, per usual, have covered this very well. One little thing to add is that as a palliative physician, I often get consulted for patients with 'uncontrolled pain' only to find that they have been chronically on a decently high OME regimen for chronic or malignan...

Very difficult question, and I think it is very dependent on the situation/reason to be on opioids. I think the most important aspect is what their follow-up is. Who will be prescribing these medications in the future? Ideally, they should follow up with a pain management doctor if they are on chron...

Agree with all in this thread. I'll put a finer point on it -- modifying an opiate pain regimen while a patient is in the hospital, without confirming and communicating with an outpatient prescriber, should never occur. In addition, inpatient providers need to be specifically cognizant of strategies...

All the preceding advice is excellent, and I want to expand on @Dr. First Last's comment on switching to Buprenorphine in the inpatient setting. Not all of us are experienced with Buprenorphine, but one of its superpowers is that it does not cause respiratory depression like full agonist opioids. An...

Tapering off opioids is incredibly difficult for the patient and provider. Most patients will have long-term complications from opioids, such as dependence, tolerance, visceral hyperalgesia (chronic abdominal pain), and testosterone deficiency (opioid induced hypogonadism). Patients resist because t...