Is it possible to taper off opiates

The latter group will need a more structured tapering regimen to avoid withdrawal. This regimen may need to be spread out over several weeks to months. The latter group will also need psychosocial support, particularly if the patient has been taking opioids for years. Many practitioners, particularly specialists, tend to have their own formulas for managing opioid tapers.

However, there is no single strategy that can be applied to all patients, and each situation must be handled on an individual basis. The literature is not clear with respect to the dose intensity and schedule for opioid tapers. As can be seen in Table 2 , dose reductions and schedules are highly variable across a variety of published clinical guidelines.

These guidelines also offer differing opinions with respect to the actual opioid being used and dosing parameters. This variability, even within the same reference, leads to uncertainty when establishing a tapering regimen.

It is useful to remember that there are multiple factors to consider with respect to determining the rate of an opioid taper. The data discussed in the previous paragraph primarily focus on avoidance of a withdrawal reaction secondary to physical dependence. As such, avoidance of the physical sequelae with an opioid taper would appear to be accomplished in most patients in very short order eg, 1 or 2 weeks.

At the same time, many of these patients may require a more individualized approach because of various physical and psychological comorbidities. Examples where a slower, individualized approach will likely be necessary include patients with comorbid cardiorespiratory disease, anxiety, or psychological dependence on opioids or patients who request a slow taper.

Once a decision to taper is made, use of long-acting agents eg, controlled-release hydrocodone, morphine, oxycodone, oxymorphone, and methadone , given on a consistent schedule every 8 to 12 hours is preferable. Use of short-acting agents eg, hydrocodone or oxycodone combination products or immediate-release morphine, oxycodone, oxymorphone, hydromorphone , especially on an as-needed schedule, is not recommended.

One guideline suggests switching patients to morphine, especially if they are experiencing addiction with oxycodone or hydrocodone. In a similar fashion, two guidelines describe converting transdermal fentanyl to an oral long-acting opioid to facilitate the tapering process.

Additional considerations include frequency of assessment and access to medication. Frequent monitoring visits are likely necessary for many patients and should be scheduled in a manner that facilitates assessment of the patient's pain status and function and occurrence of any withdrawal symptoms. The frequency at which medication is prescribed and dispensed should match a patient's ability to appropriately control and manage his or her opioid use.

This may dictate that some patients will require smaller quantities provided at short intervals, possibly as often as daily. Holding or discontinuing a taper may become necessary for a specific patient.

Events such as withdrawal, pain crisis, worsening of mood, or impairment of physical function may be predictors for slowing or stopping the tapering process. Individual patients may have differing responses to the tapering regimen chosen. Patients may be concerned about the recurrence or worsening of pain. These patients may also be concerned about developing withdrawal symptoms. Typically, the last stage of tapering is the most difficult.

The body adapts fairly well to the proportional dosage reduction to a point. For example, if a taper has been decreasing at a rate of 10 mg per week, consider decreasing at 5 mg per week to prevent withdrawal. This threshold phenomenon seems to be the case across opioids. See Boxes 1 and 2 for further examples. Furthermore, patients may not be emotionally ready for the next stage of dose reduction. If the patient has been making a reasonable effort and has followed through with the tapering plan, slowing the taper may be the most reasonable adjustment.

Refer to Boxes 1 through 4 for examples of several tapering schedules. A patient who has been taking methadone for back pain has required escalating doses during the past 3 months without any noted pain relief. Because her pain is not opioid-responsive, you would like to taper her off methadone and try another approach.

She is currently taking 40 mg methadone three times a day; there is no acute need to taper her rapidly, so a slow taper is reasonable. Week 5: 10 mg every day before noon, 5 mg every day at noon, 10 mg every day after noon or in the evening. Week 6: 5 mg every day before noon, 5 mg every day at noon, 10 mg every day after noon or in the evening. Week 7: 5 mg every day before noon, 5 mg every day at noon, 5 mg every day after noon or in the evening.

Week 8: 5 mg every day before noon, 2. Week 9: 2. A patient is having intolerable constipation with controlled release morphine, and you have tried every option for a bowel regimen without success. The patient has had to go to the emergency department for bowel evacuation twice.

The patient is currently taking mg morphine twice a day total mg daily. She is currently taking 2 tablets every 6 hours 8 tablets per day. He is not certain this has been helping his pain very much, and it is quite expensive. There is a problem with information submitted for this request. Sign up for free, and stay up-to-date on research advancements, health tips and current health topics, like COVID, plus expert advice on managing your health.

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This content does not have an Arabic version. See more conditions. Tapering off opioids: When and how. Products and services. Tapering off opioids: When and how If you've taken opioid medications for more than a couple of weeks, it's likely you need to stop soon — and stop slowly, to avoid severe symptoms of withdrawal.

By Mayo Clinic Staff. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Please try again. Something went wrong on our side, please try again. Show references Pocket guide: Tapering opioids for chronic pain.

Centers for Disease Control and Prevention. Accessed Dec. Murphy L, et al. Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions. Canadian Pharmacists Journal. HHS guide for clinicians on the appropriate dosage reduction or discontinuation of long-term opioid analgesics. Department of Health and Human Services.

FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering.

Food and Drug Administration. Tapering opioid therapy adult. Mayo Clinic; CDC guideline for prescribing opioids for chronic pain — United States, For some patients, withdrawal may last longer. Some patients that have been on high-dose opioids may experience generalized tiredness or feel unwell for a few weeks.

Patients who have been taking opioids long-term more than six months should discuss with their physician their desire to decrease their opioid use. Physicians and patients should work together to develop a treatment plan to manage withdrawal symptoms. Fast tapering will usually cause severe withdrawal symptoms, which will last for a short period. It is recommended that patients try not to increase the interval between each dose but lower the dose instead.

Once patients are on the lowest dose of an opioid, they will then be asked to decrease the frequency of use by one tablet every week and leaving the nighttime dose as the last dose before stopping completely.

Some patients who have been taking opioid medications for two weeks or less may be able to stop without feeling withdrawal. While this is unique to every patient, in most instances, the body has not developed tolerance during that time frame. For patients who have been taking more than six tablets per day, tapering use down by one tablet every 2 to 3 days is recommended see a detailed tapering plan for these instances below. A tapering plan may be beneficial for patients who have been taking opioid medications multiple times a day for more than two weeks but less than six months:.

This might limit the intensity of your withdrawal. However, given the compulsive nature of addiction, most people find self-regulated tapering to be impossible. It often leads to a full relapse into addiction. Dehydration due to vomiting and diarrhea is common and could lead to serious health complications. Drinking plenty of hydrating fluids during withdrawal is very important.

Electrolyte solutions, such as Pedialyte, may help keep you hydrated. Using the correct doses of over-the-counter OTC medications can help. Consider loperamide Imodium for diarrhea. You can also try antihistamines like Benadryl. Aches and pains that seem to crop up everywhere can be treated with acetaminophen Tylenol or nonsteroidal anti-inflammatory drugs NSAIDs like ibuprofen Motrin , Advil.

Never use any medication for longer than its recommended usage or in larger doses than recommended. Preparation can be essential. Withdrawal symptoms can last from days to weeks. But be careful not to use these medications in amounts greater than the recommended dose. In the case of acupuncture, several studies demonstrated reduced withdrawal symptoms when combined with certain medicines. The report of studies on Chinese herbal medications found that the herbs were actually more effective at managing withdrawal symptoms than clonidine was.

People who have gone through withdrawal recommend trying to stay as comfortable as possible. Keep your mind occupied with movies, books, or other distractions. Make sure you have soft blankets, a fan, and extra sheets. You may need to change your bedding due to excessive sweating.

Make sure a friend or family member knows that you plan on attempting the withdrawal process. Be cautious of recipes and anecdotal stories described in online forums. None of them have gone through rigorous testing for safety or efficacy.

This can improve your chances for long-term success.