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Chronic opioid therapy reassessment — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareChronic opioid therapy reassessmentUSMLE Step 3

A 64-year-old has used hydrocodone-acetaminophen continuously for 3 years for mechanical back pain. Constipation and sedation now interfere with work, function has declined, and two dose increases produced no durable benefit. Monitoring data are concordant, there is no opioid use disorder or imminent overdose risk, and he fears withdrawal after a prior rapid reduction. Which plan best balances benefit and harm?

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Correct answer: B — Begin a collaborative taper near 10% monthly, slowing further if withdrawal or function worsens

The best answer is “Begin a collaborative taper near 10% monthly, slowing further if withdrawal or function worsens”. For long-term opioid therapy whose harms now outweigh sustained functional benefit, CDC recommends shared decision-making, optimization of nonopioid treatment, and an individualized gradual taper rather than abrupt or clinician-imposed discontinuation. After use for a year or longer, tapers of about 10% per month or slower are often better tolerated; pauses and further slowing are appropriate when withdrawal or functional destabilization occurs.

Reference: CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm