How to Taper off Opioids

Opioids are among the most prescribed medications in the United States. These drugs are intended to be used as painkillers, but there has been an increased prevalence of recreational misuse over the last few decades. In addition to this trend, several illicit, non-medical versions of opioids have gained traction, namely heroin and fentanyl, among others.

Opioids are habit-forming compounds with a high potential for tolerance and dependence to develop. Each drug, whether natural, semisynthetic or synthetic, binds to opioid receptors in the central nervous system. Once used, dependence can quickly develop. The intensity of the dependence on each user and their use behavior — but opioids are especially addictive substances when used recreationally or otherwise.

To call opioid use addiction and overdose an issue is a gross understatement. The nation faces an epidemic. Millions of pills are being prescribed every year. States are doing their best to combat the crisis from every angle, but it will still take years to see if prescription limitations and legislation will have the ability to quell the spread of more potent opioids such as fentanyl. This appears to be where the real danger lies — cheaper and stronger opioid analogs that acquire new users from prescription drug dependencies that cannot be financially sustained.

Treatment is not only readily available across the country, but methods are effective in treating patients with opioid substance use disorders. In a clinical setting, physicians will often choose a detox approach as the first means of treating opioid addiction. Whether tapering from recreational use or from a dependence, tapering off opioids is a successful treatment method.

Tapering Off Opioids | How to Taper Off Opioids
Tapering is intended to circumvent or lessen the effects of withdrawal while allowing the body to adapt to life without the drug in question. Opioid withdrawals are uncomfortable and it is the fear of experiencing withdrawal symptoms that often prevents users from seeking help. Users are either taking the drugs to prevent pain if they have a prescription or to achieve a euphoric high if they are ingesting them recreationally.

Opioid withdrawal symptoms take many forms and levels of intensity depending on the frequency of use and the drugs used. Opioids and opiates fall into two distinct categories — short-acting or long-acting opioids — and thus these symptoms may arise at different intervals. For example, an individual consuming opioids with a short-acting formulation will begin to show withdrawal symptoms as soon as six hours after their last dose wears off. This can be as lengthy as 30 hours for the long-acting variants. Withdrawal symptoms that may be present include:

  • Aching of muscles, bones or soft tissues
  • Insomnia
  • Anxiety
  • Nausea and diarrhea
  • Runny nose or watery eyes
  • Profuse sweating or fever symptoms
  • Cramps in the abdominal region
  • Psychological symptoms such as cravings or depression

These symptoms may occur anytime between the first few hours after the final dose to longer than 10 days. Some severe opioid withdrawals can have life-threatening repercussions if not addressed.

Tapering off opioids seeks to lessen the burden of such withdrawals and allow the user to focus their energy and effort on achieving recovery rather than aggravating symptoms. Again, the intensity and scope of withdrawal are contingent on the user.

Slower tapering approaches can span months or even years, while rapid approaches take place over days or weeks. Generally speaking, somewhere in the middle of the spectrum is considered best practice. With this method, physicians are looking to reduce opioid use by 5–20 percent every month. Similar methodology and an opioid taper calculator can be adopted for at-home tapering, though this is not recommended as a long-term alternative to clinical care.

The general rule of thumb for opioid use disorder treatment: if the patient is stable and used long-acting drugs, the slower the taper should be. And vice versa for faster tapers.

When determining how to perform a medical taper, doctors often use an opioid taper calculator. Known as a MED, or Morphine Equivalent Dose calculator, this tool allows physicians to convert a patient’s opioid of choice and its related dosage to a baseline opioid: morphine. From here, it becomes much easier to administer methadone, buprenorphine or another replacement drug to begin treatment.

Opioid tapering can be a long, challenging process. While this can be done successfully as a self-detox process, it will require equal parts planning and persistence. For the best results, seek out medical intervention for yourself or a loved one.


How to Taper off Opioids
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