Opioid Taper: How To Wean off Opioids Safely
Last Updated: November 21, 2023
Opioid addiction, also known as opioid use disorder, can have a powerful impact on a person’s life. It can negatively affect someone’s relationships, personal life and work life. Using opioids chronically leads to changes in brain chemistry, creating physical dependence. This causes withdrawal symptoms when opioids are abruptly stopped, but tapering may help decrease or prevent withdrawal symptoms.
What Is Opioid Tapering?
When opioids are abruptly stopped, distressing withdrawal symptoms can result. Opioid tapering is when the dose is decreased over a period of time rather than stopped abruptly. This helps decrease—or eliminate—those uncomfortable withdrawal symptoms.
There’s no one-size-fits-all way to taper opioids. Doses are gradually reduced over time, but the speed at which this happens can vary from days to years. The speed of a taper can also change depending on how a person responds to the current taper schedule, so close monitoring is important. During an opioid taper, a medical professional will check in with the person closely to check for withdrawal symptoms, pain and any other issues that need to be addressed.
Opioid tapers can be done in an inpatient or outpatient setting. One key factor in determining the setting of an opioid taper is the speed at which it’s being done, but many things can affect what treatment setting is right for each person. A physician can help you decide which treatment setting will work best.
Why Taper off Opioids?
Tapering off of opioids can be something to consider for multiple reasons. A person might consider tapering off their opioid if:
- The opioid hasn’t been helpful in treating pain
- They are having major side effects (like constipation or drowsiness) from the opioid
- The opioid is at a high dose that puts them at an increased risk for side effects or overdose
- They have other medical conditions that increase the opioid’s risk (such as chronic obstructive pulmonary disease)
- They have other mental health conditions that increase the opioid’s risk (such as depression)
- They are on other medications (such as benzodiazepines) that increase the risk of opioid-related side effects or overdose
- They have experienced an overdose
- They have concerns about an opioid addiction or opioid use disorder
Opioid use disorder is defined through the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Criteria include:
- Using opioids in larger amounts or over longer periods of time than intended
- Having a desire to or unsuccessful attempts to decrease opioid use
- Spending excess time obtaining, using or recovering from using opioids
- Having cravings for opioids
- Using opioids despite it interfering with work, home or school responsibilities
- Using opioids despite it causing persistent social or interpersonal issues
- Not engaging in social, work or recreational activities in favor of using opioids
- Using opioids in situations where it is physically hazardous
- Continuing to use opioids despite being aware of physical or psychological problems from opioid use
- If not prescribed opioids:
- Building a tolerance, such as needing more opioids to get the same effect, or the same amount of opioid having less effect than it used to
- Experiencing opioid withdrawal symptoms when not using or taking opioids to avoid or relieve withdrawal symptoms
It’s important to note that physical dependence can happen to anyone taking opioids, even when taken exactly as prescribed. This means that abruptly stopping any opioid—even prescription opioids—can lead to withdrawal symptoms, which can be dangerous. It’s important to not abruptly stop opioids and to discuss a taper plan with your doctor.
How To Taper off Opioids
Tapering off opioids looks a little bit different for each person. During the taper process, you will work closely with your doctor and develop a personalized tapering schedule. Slower tapers, over months to years, generally are better tolerated. However, in some instances, such as if there is a major safety concern (such as a high risk of overdose), tapers can be done over days to weeks. Your doctor will also frequently follow up during the taper process to make sure that the schedule doesn’t need adjustment. They may prescribe medications to help with any withdrawal symptoms.
Medication-assisted treatment, or medications for opioid use disorder, can be a helpful tool for tapering off opioids and for long-term treatment. Two medications for opioid use disorder can also be used for managing withdrawal symptoms when detoxing off of opioids.
- Methadone is an opioid that has been used for decades in opioid use disorder treatment. It is also helpful for chronic pain. It can be used as a taper when detoxing off opioids, but some people can be on it for years for the treatment of opioid use disorder.
- Buprenorphine is unique in that it is a partial opioid agonist. This means that it only has a partial effect on the opioid receptor and has a “ceiling effect,” which can make it better tolerated. A person typically has to be in moderate withdrawal before starting buprenorphine, but it can be helpful for relieving withdrawal symptoms at that point. People can also remain on it longer term for treatment of opioid use disorder and pain.
- Buprenorphine is also available in combination with naloxone (as Suboxone), which prevents misuse through injection.
Can You Taper off Opioids Without Withdrawal?
Tapering off of opioids with little to no withdrawal is possible. During medically managed withdrawal, healthcare professionals will monitor you closely for withdrawal symptoms. If you get withdrawal symptoms, the taper may be slowed down to decrease the symptoms.
There are also non-opioid medications that can decrease withdrawal symptoms. Two alpha-2 adrenergic antagonists, clonidine and lofexidine, can help relieve opioid withdrawal symptoms. During opioid withdrawal, there’s an increase in “fight-or-flight” chemicals like adrenaline that medications like clonidine and lofexidine help slow down. These are typically given as a taper over two to four days. Lofexidine is FDA-approved for opioid withdrawal. Clonidine iis commonly used off-label due to cost and is also effective.
Signs of Opioid Withdrawal
Some signs and symptoms of opioid withdrawal to look out for include:
- Dilated pupils
- Runny nose and eyes
- Anxiety and irritability
- Trouble sleeping
- Muscle aches
- Stomach cramps
- Nausea and vomiting
- Increased blood pressure
- Increased heart rate
Medical Detox Treatment
Medical detox involves tapering off opioids under close medical supervision. The focus of detox is managing the initial withdrawal symptoms as the opioids leave your body and connecting you to resources to help with the next step of your recovery.
Medical detox can be done inpatient or outpatient. Inpatient detox is where someone checks into a treatment center and stays there for the duration of their detox. There’s no access to substances, and patients can get out of a triggering environment. They’re also closely monitored, and if anything goes wrong, it can quickly be addressed by medical professionals. However, it can be costly, and it can be easy to return to substance use after leaving such a controlled environment without a follow-up plan in place.
Outpatient detox involves going to a treatment center daily for detox treatment and assessment and returning home. How long patients spend at the center can vary between places and programs. Some advantages are that it is usually cheaper, and people can continue to work and tend to their other responsibilities. However, they might find it harder to stay away from opioids, and if any medical issue happens, it can’t be addressed as quickly.
It’s important to combine medical detox with other treatments, such as counseling and medications for opioid use disorder. There’s a high relapse rate when medical detox is done alone as a treatment for opioid use disorder because it doesn’t address the physical or psychological reasons for using.
Opioid Addiction Treatment at The Recovery Village Kansas City
The Recovery Village Kansas City is led by experienced, board-certified addiction specialists and offers a continuum of care—from medical detox to residential rehab, partial hospitalization and intensive outpatient programs. We offer personalized treatment plans and evidence-based treatments, including counseling, medical detox and medications for opioid use disorder. Same-day admissions are also available.
If you or a loved one lives with opioid addiction or opioid use disorder, contact a Recovery Advocate today to learn which of our programs may be right for you.
MedlinePlus. “Opioid Addiction.” Updated November 1, 2017. Accessed October 8, 2023.
U.S. Food and Drug Administration. “FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering.” Updated January 12, 2022. Accessed October 8, 2023.
U.S. Department of Veterans Affairs. “Opioid Taper Decision Tool.” Updated October 2016. Accessed October 8, 2023.
Centers for Disease Control and Prevention. “Opioid Use Disorder: Preventing and Treating.” Updated February 1, 2023. Accessed October 8, 2023.
Srivastava, A. Benjamin; Mariani, John J.; & Levin, Frances R. “New directions in the treatment of opioid withdrawal.” Lancet, June 2020. Accessed October 8, 2023.
American Society of Addiction Medicine. “National Practice Guideline for the Treatment of Opioid Use Disorder.” December 18, 2019. Accessed October 8, 2023.
Providers Clinical Support System. “Medically Supervised Withdrawal (Detoxification) from Opioids.” Updated June 11, 2021. Accessed October 8, 2023.