How to taper off opioid replacement medication

opiate replacement medication

Opioids are a class of drug that are usually used to treat pain. Legal ones include morphine, methadone, Buprenorphine, hydrocodone, and oxycodone. Heroin is also a type of opioid but is an illegal one.

Opioid replacement therapy is a type of treatment for those who may be addicted to opioids. In short, the idea behind the therapy is that it replaces dangerous opioids — like heroin — with legal drugs, such as methadone or Suboxone. Of course, this is not a permanent option, and a person will eventually have to taper off of the replacement medication.

The reasoning behind this type of treatment is that when a person is addicted to an opioid, their brain chemistry is affected. According to, “Opiates increase the amount of dopamine released in the brain reward system and mimic the effects of endogenous opioids. Heroin injected into a vein reaches the brain in 15 to 20 seconds and binds to opiate receptors found in many brain regions, including the reward system. Activation of the receptors in the reward circuits causes a brief rush of intense euphoria, followed by a couple of hours of a relaxed, contented state.”

Because opioids affect the brain this way and leave it wanting more, it becomes nearly impossible and even dangerous for a person to simply stop taking a drug like heroin. This is where opioid replacement therapy comes into play. The idea is that by replacing an illicit opioid with a legal one, a person will not be at risk for the dangers that can occur when stopping an opioids cold turkey. Taking part in opioid replacement therapy allows a person to be monitored by a medical professional as they slowly come off of opioids over a period of time. While this is occurring, they can also take part in other aspects of treatment, like counseling.

What is opioid replacement therapy?

Though helpful for some, replacement drugs like methadone and suboxone are not a permanent solution for opioid addiction. Eventually, their use must also be stopped, as they can also be addictive. The best way stop use altogether is by tapering, which means lowering the amount of the drug taken over an extended period of time, rather than all at once. This time may be different for each individual. An article titled “Safely Discontinuing Opioid Analgesics” states, “The duration of the taper depends on its complexity and the patient’s needs. The universal goal is to taper as quickly as the patient’s physiologic and psychological status allows.”

For a replacement drug like methadone, the suggested taper time depends on the dose of methadone a person is on, and how long they have been on it. According to Opiate Addiction Support, “Decrease by increments of 10% of your daily dose every 1-2 weeks until you reach 1/3 of the original dose. At that point begin tapering methadone at half the previous rate.” The same site also suggests that a rate that exceeds 5 milligrams per week is not suggested. Though tapering should help to avoid serious withdrawals, users may still experience some such as chills, fever, anxiety, muscle aches and pains, nausea, sweating, rapid heartbeat, stomach cramps and more.

But methadone isn’t the only replacement drug out there, as Suboxone is another popular one. Suboxone, according to, “contains a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication…Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse.”

According to Opiate Addiction Support, two to six months is an average timeframe for tapering off suboxone. Matt Finch, a former opiate addict, suboxone patient and counselor at an opiate treatment program, gives the following advice:

  • Use the least amount of medication possible to feel well enough to get through the day.
  • Resist urges to use a little extra when you’re not feeling great, which can mess with the taper process.
  • Try to take it only once every 24 hours.
  • Listen to your body and adjust tapering speed as needed.
  • Don’t obsess about it.

Finch also states that the best way to taper off suboxone and do so successfully is by using a method called the four-pillar method.

  • This method first addresses a person’s physical state, stressing the importance of exercise and nutrition during time spent tapering from a medication.
  • The second pillar has to do with a person’s psychological state, which Finch says can be the toughest to address. When a person is tapering off a medication, their emotions often become thrown off, and recognizing that it is temporary is important.
  • Third, this approach examines emotional patterns and how to shift them.
  • And finally, this approach looks at spirituality, which Finch says is vital in coming off of a medication, though this does not have to have a religious affiliation.
Tapering off any medication takes patience and diligence.

It is not a fast process, but it is a necessary one in order to take care of your body and your mind. If you are unsure how to begin the tapering process, consult a medical professional.

How to taper off opioid replacement medication
How Would You Rate This Page?