1. Talk with Your Doctor

Knowing that surgery is the biggest risk factor for long-term opiate use and chronic dependence, patients should start by talking openly with their physician. This means asking questions to understand their options before going into surgery. According to Maryam, the two biggest questions are, “Will I be prescribed opioids?” and “What can I expect my quality of what to look like if and once I do take them?” Patients can then discuss the expectations of what they want their life to look like after surgery. For example, will they return to work? How can their daily life, leisure activities, and intimate relationships remain intact?

2. Find a Support Team

It’s important that patients have both personal and professional support structures in place. Personal support can come from family, friends, or clergy, for example, while a professional support person or team can enhance the support circle. For example, a patient might be hesitant to discuss concerns about weight gain or intimacy after surgery with a significant other. This is where turning to a behavioral therapist or a psychologist can help the patient address those quality of life concerns that involve relationships, daily activity, and employment. 

3. Engage in Mind-Body Therapies

Non-medication therapies like cognitive behavioral therapy (CBT), mindfulness, and meditation can greatly benefit patients in managing pain. “Make sure you know whoever is leading your therapies is appropriately licensed and trained,” Maryam says. She urges patients to better understand CBT by asking questions about what it includes, and even including their personal support structures in that process. “Care providers or romantic partners tend to bear quite a bit of burden right after a loved one’s surgery. Including these caretakers in these mind-body and other therapies can help them as they may start to experience their own limitations or deterioration of quality of life.

4. Come up with an Exit Plan

When taking opioids, patients will want to work with their support team to come up with an exit plan—including a timeline by which they plan to taper off the medicine. Statistics show that the length of time a person takes opioids (not their dosage) most strongly increases their chance of medication dependence. “The exit plan should include the prescriber, members of the professional support they’re receiving, for example, their therapist, as well as their personal support system,” Maryam adds.

5. Do Your Research

Rather than digging into scientific studies themselves, patients should feel comfortable reaching out to their professional support team for guidance on tapering off opioids. 

• For further information, patients can refer to scientific and reputable institutions like Health and Human Services and the Centers for Disease Control and Prevention for guidelines on taking and discontinuing opioids. 
• The U.S. Department of Veteran Affairs also shares recommendations for managing chronic pain with medications. 
• The Substance Abuse and Mental Health Services Administration has several helpful tools for patients and physicians regarding mental health professional support.