Deprescribing is the process of gradually stopping a long-term medication to reduce risks, improve quality of life, and manage polypharmacy. This can occur in various medical contexts, including within addiction recovery, during which careful planning, monitoring, and support are required.Â
- Deprescribing involves reducing and stopping a prescribed medication that is no longer needed or is clinically inappropriate or harmful.
- People in addiction recovery might need medications initially that become unnecessary as they progress through their recovery process.
- Deprescribing should involve input from the patient and any medical professionals involved in their care.
What is deprescribing?
Deprescribing is a term used to describe the discontinuation of prescription medications that are no longer necessary, appropriate, or that may be causing harm to the individual. It involves a structured withdrawal, taper, or discontinuation of one or more medications with careful monitoring and supervision. [1]
Medications are deprescribed when: [1][2][3]
- The individual is taking many medications (polypharmacy) that may not all be necessary or are not relieving the targeted symptoms.
- Medications are suspected to be causing harm, such as interactions with other substances, adverse effects, risk of falls, or addiction risks.
- A prescribed medication has been used for longer than is clinically necessary or recommended.
- A medication is continuing to be used despite no longer being required for symptom management.
- An individual patient expresses a desire to stop or reduce their intake of medication.
In scientific literature, this is most often discussed in the context of older adults or end-of-life care, as this is when it is most common for polypharmacy or increased risks to occur. However, it can also apply in other medical situations, including in substance use disorder treatment. Deprescribing is intended to improve quality of life and reduce associated risks. [1][2]
Deprescribing in addiction treatment
People with substance use issues often experience co-occurring mental health conditions, such as anxiety, post-traumatic stress disorder (PTSD), and depression. Medications to help manage these conditions may be of particular benefit at the start of recovery, as this process can be challenging and symptoms can worsen during this time, and impact outcomes. [4]
As recovery progresses, these conditions might improve, and medications may no longer be necessary. At this point, a safe deprescribing and tapering schedule that supports the recovery process can be beneficial.
Why deprescribing can support recovery
Deprescribing can benefit individuals in recovery by: [1][2][4][5]
- Reducing the number of substances used, particularly if medications can contribute to physical dependence or addiction risks.
- Encouraging the use of coping strategies and recovery skills learned through therapies and behavioral interventions.
- Helping improve self-efficacy and confidence in recovery.
- Reducing risks of drug interactions, adverse effects, and health risks of chronic medication use.
- Reducing the cost and burden of prescribed medications.
Medications commonly deprescribed in recovery
Medications that might be considered for deprescribing among individuals in recovery include any potentially addictive medication, such as:Â
- Opioids
- Benzodiazepines
- Barbiturates and sedatives
- Medications for attention-deficit/hyperactivity disorder (ADHD)
Additionally, medications such as antidepressants might have been prescribed in the early stages of recovery and become no longer necessary as the individual progresses with their recovery. [4]
Who is deprescribing best for?
Most often, deprescribing is implemented among older adults or people with multiple conditions, as these groups are the most likely to be taking several medications for prolonged periods. [1][3]
Similarly, it can be common for people with SUD to have several physical and mental health conditions that require pharmaceutical treatment, alongside medications prescribed to help manage substance addictions. This can, therefore, contribute to polypharmacy, thereby requiring deprescribing. [4][5]
People in SUD recovery who are prescribed medications that can lead to physical dependence or addiction might benefit from deprescribing and can discuss this with a medical professional.
Deprescribing vs. Tapering vs. Detox
Deprescribing, tapering, and detoxification all refer to the reduction and discontinuation of a substance, but they differ in terms of their clinical purpose and processes.
Detoxification, or detox, refers to the process of reducing and stopping an addictive substance, eliminating the substance from the body, and managing the withdrawal symptoms that can occur. Depending on the type of drug or medication, this may require professional involvement, as it can be unpleasant or dangerous.
Deprescribing is a structured and supervised process that involves carefully stopping a medication that has been used long-term, that has become harmful or unnecessary. [2] Sometimes, the safest and best way to do this is through a gradual tapering process, which is supervised by a prescribing professional.
Tapering is the gradual dose reduction of a medication that leads to complete discontinuation. It is a method that can be used as part of the deprescribing process or other treatment changes.Â
Risks and limitations of deprescribing
Potential risks and limitations of deprescribing can include: [2][4][6]
- Unmanaged or rebound symptoms: The condition being treated may recur or worsen when treatment is stopped, or rebound symptoms can emerge. This can be harmful and may differ depending on the substance and condition treated.
- Withdrawal symptoms: Some medications can cause physical dependence, leading to withdrawal symptoms when discontinued, especially when rapidly stopped. Because of this, a gradual taper is often recommended for these types of medications.
- Relapse risk: People in recovery might be at increased risk of relapse if a medication is reduced or stopped, even if their addiction is not associated with this substance. As such, deprescribing in recovery requires careful planning and support.
How deprescribing is done safely
The following can be implemented to ensure deprescribing is conducted safely: [2][3][4]
- Discussing with the patient before commencing, including the rationale for deprescribing.
- Developing the deprescribing plan with the patient’s input, ensuring they are involved in the planning of their tapering schedule or changes to their treatment, and can prepare themselves for this process.
- Offering non-pharmacological support throughout the deprescribing process, including lifestyle adjustments, therapies, and behavioral interventions.
- Utilizing standard de-prescribing guidelines to inform the process, along with input from various healthcare professionals as needed.
- Ensuring careful monitoring as medications are reduced, checking for signs of withdrawal symptoms, rebound symptoms, or substance use relapse, and implementing any appropriate and necessary treatments.
- Exploring options to slowly taper off medications that are likely to cause withdrawals, rather than stopping them suddenly.
- Scheduling regular and frequent follow-up visits after the person reduces their dose or stops a medication to track symptoms and status, and to make adjustments to the tapering schedule as needed.
- Linking the patient with external resources, supports, and wrap-around treatment to ensure ongoing participation in recovery programs and communities.
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