Module 2: Basic Pharmacology of Controlled Drugs and Substances

Lesson 4


At times, it may be necessary to change your patient’s prescribed controlled drug or substance due to suboptimal symptom management or adverse reactions. For opioids, this process is sometimes referred to as opioid rotation (Smith & Peppin, 2014). Prescribers and patients may also wish to reduce or discontinue prescribed controlled drugs and substances, sometimes also referred to as “de-prescribing”. Thompson and Farrell (2013) define de-prescribing as a means of improving client outcomes by decreasing or stopping prescribed controlled drugs and substances that are no longer providing the desired therapeutic effect or improving client functioning. The process must be carefully planned and managed to avoid undesirable effects related to the withdrawal process itself.