Drug Tapering: How to Taper Off Opioids & Risks of Withdrawal

What is Opioid Tapering?

Opioid tapering involves providing gradually decreasing doses of an opioid to reduce withdrawal symptoms and increase a person’s safety through the detox process.²

Opioid tapering can occur in a variety of settings, including an inpatient and outpatient basis.²  Physicians who prescribe opioid tapers on an outpatient basis may monitor progress more closely than in other settings.^{2, 8}

Why Taper Off Opioids?

Opioids are primarily used to manage severe pain.^{1, 3} Opioids, including both prescription medications (e.g., morphine, OxyContin, Vicodin, fentanyl) and illicit substances such as heroin, have a strong potential for abuse and addiction.^1,2,3

Even when taken as prescribed, it is possible to become physically dependent on opioids.^{1, 2} Over time, the body adjusts to the presence of the drug, and when use is suddenly stopped, unpleasant and painful—sometimes life-threatening—withdrawal symptoms can occur.^{1, 2, 4}

Physical dependence on opioids and experiencing withdrawal symptoms may be a sign of an opioid use disorder (OUD).^{4, 5} An OUD can negatively impact your physical health, mental health, relationships, career, and finances.^{5, 6}

People with an OUD often have difficulty maintaining control over their opioid use and may not be able to stop using even if they want to.⁵ An inability to stop using even after it has caused or worsened physical or mental health, or relationship issues is sign of addiction.⁵ Cravings and withdrawal can make it difficult to stop using opioids without professional help.^{5, 6}

The majority of people who have an OUD experience withdrawal at some point.⁵ Withdrawal symptoms vary depending on which opioid is used, how much has been used, how long it has been used, a person’s individual makeup, and if there are any physical or mental health issues present.¹ Polysubstance abuse, which is when a person abuses more than one substance, may also complicate withdrawal.²

Quitting opioids suddenly, or going cold turkey, even after as little as 2-10 days of continuous use ⁷, will produce withdrawal symptoms that may cause mental and emotional distress, increased pain, increased risk for suicide, and unmanageable withdrawal symptoms that may lead to relapse.^{8, 9}

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How to Taper Off Opioids

Tapering off opioids can be difficult to do without the proper support. When a medical professional works with a patient to taper them off prescription opioids, an individualized schedule should be created to manage withdrawal symptoms following a complete physical assessment , lab tests and interview.^{8, 9} How quickly the medication is tapered depends on several factors, including how long you have been taking opioids, the dose you have been taking, and which opioid and other medications or substances you have been using.^{9, 8}

Medication-assisted treatment uses prescription medication to help stabilize a patient as they come off prescription or illicit opioids.¹² Treatment medications are started during the withdrawal process and can be continued until the patient is ready to be weaned off them.¹² These medications may be prescribed on an outpatient basis and allow people to receive effective care without significant disruption to their daily lives.¹² Others may need close medical supervision and require inpatient care. There is no one-size fits all approach, and an individualized assessment is critical to ensure successful management of withdrawal.¹⁰

The most commonly used treatment medications are methadone, buprenorphine, and suboxone.^{2, 12}  Both are opioids themselves and they are prescribed to reduce withdrawal symptoms and opioid cravings while blocking of blunting the effects of any other opioids that are taken.^{12, 13, 14}

When tapering off opioids using medication, it is important to follow the guidance of the prescribing doctor.¹² Medical supervision is important when tapering off opioids, because a patient can be closely monitored and assisted with symptoms, the dosage can be adjusted, and additional support provided as needed.^{8, 9}

Can You Taper Off Opioids Without Withdrawal

Experiencing some amount of withdrawal may be inevitable, but professional detox that’s managed by an experienced medical professional can make the process safer, more comfortable, and much more manageable than it would otherwise be.^{2, 15} Your doctor can closely monitor your progress and tailor treatment to meet your needs.⁹ To ensure the safest of the patient, having a medical professional oversee treatment allows them to observe any symptoms that you may still be experiencing so that your dosage can be adjusted appropriately.⁹

Even while going through a medical detox and taking prescribed medications, such as methadone or buprenorphine, some people may still experience reduced withdrawal symptoms.^{2, 4} In situations like these, additional medications can be prescribed in an effort to alleviate specific withdrawal symptoms.² For example, clonidine is a blood pressure medication that is commonly used off-label to treat many of the symptoms of opioid withdrawal and lofexidine is a similar drug, which is used that is approved to treat various symptoms of opioid withdrawal.^{2, 16}

Signs of Opioid Withdrawal

Acute withdrawal from opioids may show similar symptoms, regardless of whether a person is using heroin, OxyContin, Norco, Vicodin, fentanyl, or any other type of opioid.^3,5 If you are taking withdrawal management medications, you may notice some mild withdrawal symptoms.² However, you may need to discuss adjusting your dose with your doctor if you are experiencing any of the following more severe symptoms while on management medications and going through a medical detox:^{2, 5, 11}

• Abdominal cramps.
• Anxiety.
• Diarrhea.
• Fast, shallow breathing.
• Increased blood pressure.
• Insomnia.
• Nausea and vomiting.
• Rapid heart rate.

Medical Detox Treatment

Medical detox, the supervision of the detoxification process by medical staff,⁴ can be provided in a clinic or medical office setting, outpatient clinic, or inpatient facility.² Medical detox involves providing medication to manage withdrawal symptoms and closely monitoring patients for progress and potential complications.²

Medical detox is a huge step to take toward sobriety, but the main focus of detox is to help a person taper off opioids.⁴ Detox doesn’t constitute complete substance abuse treatment and should be complemented by psychosocial and recovery support services.⁴ Proper management of withdrawal can provide the stability and comfort needed to allow you to focus on additional methods of treatment that can follow medical detox, such as inpatient or outpatient treatment.⁴

Treatment at American Addiction Centers

American Addiction Centers (AAC) is at the forefront of addiction treatment in the United States, providing effective care that is tailored to meet all of your needs. There are locations across the U.S. and AAC is in-network with many insurance companies, making opioid rehab treatment available and accessible. Individualized treatment services can include:

• Medical detox.
• Residential care, which provides around-the-clock monitoring and treatment as you learn to readjust to life without using opioids over approximately 6-12 months.
• Inpatient care, which offers treatment and 24/7 monitoring while you live in a facility for a shorter period of time
• Outpatient care, which provides shorter periods of treatment while you live at home and allows you to acclimate to outside responsibilities while still receiving treatment.

If you or a loved one is wanting to learn more about the treatment options that AAC has to offer, give us a call today at . We are here 24/7 to answer your questions and provide information about our treatment programs and our facilities.

The thought of quitting opioids can be overwhelming, and you may even feel afraid or hopeless. Many treatment options are available to ease symptoms during the opioid withdrawal process with a minimum of discomfort. Asking for help is the first step to freeing yourself from a dependence on opioids and living a life free of addiction.

Sources

1. Drug Enforcement Administration. (2020). Drugs of abuse: A DEA resource guide.
2. Center for Substance Abuse Treatment. (2015). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
3. Arlington County Government. (2020). What are opioids?
4. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd edition).
5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5^th). Arlington, VA: American Psychiatric Publishing.
6. S. National Library of Medicine. (2020). Opioid addiction.
7. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
8. S. Food and Drug Administration. (2019). FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering.
9. Centers for Disease Control and Prevention. Pocket guide: Tapering opioids for chronic pain.
10. SAMHSA. (2020). Tip 63: Medications for Opioid Use Disorder.
11. S. Department of Veterans Affairs. (2016). Opioid taper decision tool.
12. Substance Abuse and Mental Health Services Administration. (2020). Medication and counseling treatment.
13. Substance Abuse and Mental Health Services Administration. (2020). Methadone.
14. Substance Abuse and Mental Health Services Administration. (2020). Buprenorphine.
15. Wallace, M.S., & Papp, A. (2018). Opioid withdrawal. In: Anitescu, M., Benzon, H., & Wallace, M. (eds.) Challenging Cases and Complication Management in Pain Medicine. Springer, Cham.
16. S. National Library of Medicine. (2020). Lofexidine.