Patient-centered opioid tapering succeeded in half of patients

Clinical takeaway: For patients receiving long-term opioid therapy, prioritize a collaborative, individualized taper with close follow-up. Adding CBT or a self-management program is unlikely to improve tapering success, although CBT may reduce withdrawal-related adverse effects.

Long-term opioid tapering can be difficult for both patients and clinicians, in part because of concerns that reducing opioid doses will worsen pain or trigger withdrawal. A large randomized trial suggests that a structured, patient-centered tapering approach can help many patients successfully reduce opioid use without routinely adding behavioral therapy.

Researchers randomly assigned 562 adults with chronic pain receiving long-term prescription opioids to patient-centered tapering alone or tapering plus cognitive behavioral therapy (CBT) or a chronic pain self-management program. All participants received individualized taper plans developed through shared decision-making, with flexible dose reductions and close clinical monitoring.

The primary outcome—reducing opioid use by at least 50% without worsening pain or improving pain without increasing opioid use—was achieved by 50.9% of patients receiving patient-centered tapering alone, 48.6% of those receiving tapering plus CBT, and 44.5% of those receiving the self-management program. Neither behavioral intervention improved tapering success compared with patient-centered tapering alone.

Study-related adverse events, including opioid withdrawal symptoms, were less common among participants who received CBT (54%) than among those assigned to tapering alone (66%), suggesting CBT may help make tapering more tolerable even if it does not increase the likelihood of success.

For clinicians, the findings suggest that successful opioid tapering may depend more on how the taper is conducted than on routinely adding behavioral therapy. A collaborative approach emphasizing shared decision-making, individualized dose reductions, and close follow-up helped about half of patients successfully taper opioids, while CBT can still be considered for those who may benefit from additional support or help managing withdrawal symptoms.

In an accompanying editorial, Mark D. Sullivan, MD, PhD, of the University of Washington, said the study's most important contribution may be demonstrating that successful opioid tapering depends less on adding specialized behavioral therapies than on delivering a truly patient-centered process. He noted that the trial emphasized shared decision-making, patient engagement, individualized taper plans, and flexibility throughout treatment—features that distinguish it from earlier, less collaborative approaches to opioid reduction.

"The patient-centered approach is what works," Dr. Sullivan concluded.

Source: Darnall BD, et al. (2026 July 7) Ann Intern Med. Patient-centered prescription opioid tapering methods: a randomized clinical trial