Open Access Open Access  Restricted Access Subscription or Fee Access

Survey of opioid tapering practices of pediatric healthcare providers: A national perspective

Deborah Fisher, PhD, RN, PPCNP-BC, Suzanne W. Ameringer, PhD, RN


Objective: The purpose of this study was to describe the current opioid tapering practice.

Design: Cross-sectional, online, survey research.

Participants: Pediatric healthcare providers from a national sample of practicing nurse practitioners, physician assistants, and physicians who participate in five different pediatric pain and/or palliative care list serves.

Results: One hundred four participants responded to the survey. The respondents were predominantly physicians (n = 58, 62 percent). The majority of respondents worked in an academic children's medical center (n = 50, 52 percent). The average number of years in pediatric practice was 16 (mean = 16.33, range of 0-45 years). Of the 104 respondents, only 22 (27 percent) had a written protocol for opioid tapering. Use of expert consultants such as pharmacists or pediatric pain management teams varied. The majority of respondents (n = 46, 44 percent) seldom or never consult a pharmacist. Only 22 percent (n = 17) almost always or always consult a pediatric pain team. There was a wide range of personal tapering rate preferences.

Conclusions: This study provided a baseline assessment of pediatric opioid tapering practices by pediatric healthcare providers. Results revealed a marked variation in practice patterns that may indicate deficits in the assessment and management of opioid withdrawal in children. The need for the development of assessment-based opioid tapering guidelines for the pediatric population is long overdue.


pediatrics, prescriber education, opioid prescribing, opioid withdrawal, survey

Full Text:



Ameringer S, Fisher D, Sreedhar S, et al.: Pediatric pain management education in medical students: Impact of a web-based module. J Palliat Med. 2012; 15: 978-983.

Chen I, Goodman B, 3rd, Galicia-Castillo M, et al.: The EVMS pain education initiative: A multifaceted approach to resident education. J Pain. 2007; 8: 152-160.

Doorenbos AZ, Gordon DB, Tauben D, et al.: A blueprint of pain curriculum across prelicensure health sciences programs: One NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience. J. Pain. 2013; 14: 1533-1538.

Tauben DJ, Loeser JD: Pain education at the University of Washington School of Medicine. J. Pain. 2013; 14: 431-437.

Berry P, Dahl JL, Donovan MI, et al.: Improving the Quality of Pain Measurement through Measurement and Action. 2003. Available at Accessed January 2, 2017.

CDC: Opioid Painkiller Prescribing, Where You Live Makes a Difference. Atlanta, GA: Centers for Disease Control and Prevention, 2014.

Manchikanti L, Helm S, 2nd, Fellows B, et al.: Opioid epidemic in the United States. Pain Phys. 2012; 15: ES9-ES38.

Fortuna RJ, Robbins BW, Mani N, et al.: Dependence on emergency care among young adults in the United States. J Gen Intern Med. 2010; 25: 663-669.

Mezei L, Murinson BB, Johns Hopkins Pain Curriculum Development Team: Pain education in North American medical schools. J. Pain. 2011; 12: 1199-1208.

Yanni LM, Priestley JW, Schlesinger JB, et al.: Development of a comprehensive e-learning resource in pain management. Pain Med. 2009; 10: 95-105.

Franck LS, Harris SK, Soetenga DJ, et al.: The Withdrawal Assessment Tool-1 (WAT-1): An assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med. 2008; 9: 573-580.

Ista E, de Hoog M, Tibboel D, et al.: Psychometric evaluation of the Sophia Observation withdrawal symptoms scale in critically ill children. Pediatr Crit Care Med. 2013; 14: 761-769.

da Silva PS, Reis ME, Fonseca TS, et al.: Opioid and benzodiazepine withdrawal syndrome in PICU patients: Which risk factors matter? J Addict Med. 2016; 10: 110-116.

Ista E, van Dijk M, Gamel C, et al.: Withdrawal symptoms in critically ill children after long-term administration of sedatives and/or analgesics: a first evaluation. Crit Care Med. 2008; 36: 2427-2432.

Fisher D, Grap MJ, Younger JB, et al.: Opioid withdrawal signs and symptoms in children: Frequency and determinants. Heart Lung. 2013; 42: 407-413.

Best KM, Asaro LA, Franck LS, et al.: Randomized evaluation of sedation titration for respiratory failure baseline study I. Patterns of sedation weaning in critically ill children recovering from acute respiratory failure. Pediatr Crit Care Med. 2016; 17: 19-29.

Franck LS, Scoppettuolo LA, Wypij D, et al.: Validity and generalizability of the Withdrawal Assessment Tool-1 (WAT-1) for monitoring iatrogenic withdrawal syndrome in pediatric patients. Pain. 2012; 153: 142-148.

Anand KJ, Arnold JH: Opioid tolerance and dependence in infants and children. Crit Care Med. 1994; 22: 334-342.

Ducharme C, Carnevale FA, Clermont MS, et al.: A prospective study of adverse reactions to the weaning of opioids and benzodiazepines among critically ill children. Intensive Crit Care Nurs. 2005; 21: 179-186.

Berens RJ, Meyer MT, Mikhailov TA, et al.: A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients. Anesth Analg. 2006; 102: 1045-1050.

Katz R, Kelly HW, Hsi A: Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion. Crit Care Med. 1994; 22: 763-767.

Franck LS, Naughton I, Winter I: Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients. Intensive Crit Care Nurs. 2004; 20: 344-351.

Fisher D: Opioid tapering in children: A review of the literature. AACN Adv Crit Care. 2010; 21: 139-145.

Playfor S, Jenkins I, Boyles C, et al.: Consensus guidelines on sedation and analgesia in critically ill children. Intensive Care Med. 2006; 32: 1125-1136.

Galinkin J, Koh JL, Committee on Drugs, et al.: Recognition and management of iatrogenically induced opioid dependence and withdrawal in children. Pediatrics. 2014; 133: 152-155.

Meyer MM, Berens RJ: Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients. Pediatr Crit Care Med. 2001; 2: 329-333.

Robertson RC, Darsey E, Fortenberry JD, et al.: Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care unit patients. Pediatr Crit Care Med. 2000; 1: 119-123.

Ista E, van Dijk M, Gischler S, et al.: Weaning of opioids and benzodiazepines at home after critical illness in infants: A cost-effective approach. J Opioid Manag. 2010; 6: 55-62.

Gowing L, Farrell M, Ali R, et al.: Alpha(2)-adrenergic agonists for the management of opioid withdrawal. Cochrane Database Syst Rev. 2016: CD002024.

Dowell D: CDC guideline for prescribing opioids for chronic pain-United States. In Haegerich TM (ed.): Morbidity and Mortality Weekly Report. Atlanta, GA: Centers for Disease Control and Prevention, 2016: 1-49.



  • There are currently no refbacks.