How to Wean off Opioids Safely with Tapering Methods

Opiates are a class of drugs used in clinical and recreational settings, and most commonly include morphine, fentanyl, codeine and opium.

• In 2021, the National Center for Health Statistics at the Centers of Disease Control and Prevention reported that opioids were involved in over 80,000 overdose fatalities — out of 106,000 total drug overdose deaths.
• While all opiates are considered opioids, all opioids are not considered opiates.
• Opioids (like morphine and oxycodone) are derived from poppy plants as opium, whereas opiates (like fentanyl) can be synthetic.
• Both opiates and opioids act on the brain similarly, with varying results.

Unfortunately, both of these classes of substances contribute to the opioid epidemic — but treatment is possible. One commonly used treatment option is to “taper off” opiates to minimize withdrawal symptoms. One opioid addiction treatment method is known as “tapering off opiates.” Here, you will learn more about this approach and how opiate taper calculators work and find other tools at your disposal.

Tapering off Opiates

Tapering has two main objectives: reduce or eliminate an otherwise unbearable opiate withdrawal and acclimate the user’s body to the absence of opiates entirely, the latter of which can potentially take years. A withdrawal is the most immediate and pressing aspect to address when tapering off opiates.

• The intensity of such withdrawals directly correlates to an individual user’s opiate-use behavior.
• The individual’s tolerance level, degree of dependence and biological makeup related to their opioid addiction also come into play.
• Opiates are characterized as short- or long-acting compounds. As the names imply, one lasts a short duration in the body while the other lasts longer.
• Opioid withdrawal symptoms usually occur much sooner for short-acting opiates.
• Withdrawal symptoms include trouble sleeping, flu-like side effects, vomiting, fever, spasms, aching, sweating, depression, anxious behavior and much more.

How to Taper off Opiates

Opiate tapers occur at different rates depending on an individual’s needs — some last mere days while others span years or the course of a lifetime. As defined by the U.S. Department of Veterans Affairs, four typical rates range from tapering down over weeks to years and differ depending on an individual’s use.

Opiate Taper Calculator

Morphine Equivalent Dose calculators, or MED, are used by licensed physicians in some tapering programs. An opioid taper calculator is designed to establish an equivalent dosage amount of morphine compared to the opiate a patient is using. With a baseline morphine dose, healthcare providers can craft a personalized tapering schedule and determine the best medication to replace the opiate.

Types of Opioids Tapering Methods

Depending on your unique case, options for how you taper off may exist. This can depend on the type of opiate you use, how long you’ve been using and your other health conditions (like kidney or liver impairment). Always consult your healthcare provider or pharmacist for the most accurate information about your situation.

Direct Tapering

Direct tapering involves slowly decreasing the amount of opioids you take over time. The U.S. Department of Veterans Affairs suggests four taper schedules that will put this into perspective:

• Slowest Taper: Reduction of opiate use by 2–10% every one or two months for several years.
• Slow Taper: Reduction of opiate use by 5–20% each month. This is the most common approach in certain subpopulations.
• Fast Taper: Reduction of opiate use by 10–20% each week. This is the taper commonly recommended by the Centers for Disease Control.
• Fastest Taper: Reduction of opiate use by 10–20% daily. This method should only be used for patients who have been using short-acting opiates for a short time. Any taper faster than this can be dangerous, and any slower can prove ineffective.

Substitute Tapering

Substitution tapering is sometimes referred to as medication-assisted treatment (MAT). The three medications approved for MAT are buprenorphine, methadone and naltrexone, and would be used in combination with counseling and psychosocial support. These medications are taken instead of an opioid, and the dose is tapered down over time to minimize withdrawal symptoms and cravings.

Titration Tapering

Titration involves dissolving a medication in water to reduce the dose slowly. This is very risky and only recommended with medical supervision.

Why Consider Tapering vs. Stop Opioids Cold Turkey?

Physicians generally advise that self-detox is not as safe or successful as the clinical alternative. Additionally, often quitting opioids or opiates cold turkey does more harm than good.

This is vital information to begin any discussion on how to taper off opiates. For most, no matter how effective an at-home effort may be, the same procedure will be more efficient and safe under the supervision of medical professionals. Furthermore, stopping opioids cold turkey can have consequences, including severe withdrawal or even death.

Common Opioid Withdrawal Symptoms

Opioid withdrawal symptoms can differ based on which opioid you use, how much you take and how long you have been using. In general, opioid withdrawal symptoms can include:

• Watery eyes
• Runny nose
• Yawning
• Sweating
• Restlessness
• Irritability
• Loss of appetite
• Nausea
• Tremors
• Drug craving
• Severe depression
• Vomiting
• Increased heart rate
• Increased blood pressure
• Chills
• Flushing
• Excessive sweating

Side Effects of Opioid Tapering

Under medical supervision, opioid tapering is safe and effective. However, if you are tapered off too quickly, especially if you try to quit cold turkey, you may experience withdrawal symptoms. Under medical supervision, your heart rate, blood pressure, electrolytes and other symptoms are regularly monitored to ensure you are getting the correct dose of medication and that your symptoms are appropriately managed.

Opioids Withdrawal Timeline

The opioid withdrawal timeline will differ from person to person and depends on whether the opioid you take is short- or long-acting. Most people will begin to feel symptoms in less than 12 hours from the last heroin use or as little as 30 minutes from the last dose of methadone.

Stage 1: Early withdrawal	Stage 2: Late withdrawal
Early withdrawal symptoms can occur in as little as hours from your last use and can last up to several weeks. Symptoms can include: – Agitation – Anxiety – Muscle aches – Increased tearing – Insomnia – Runny nose – Sweating – Yawning	Late withdrawal symptoms usually last around one to two weeks. During this time, it is important to seek counseling or therapy for the highest likelihood of success without opioids. These symptoms often include: – Abdominal cramping – Diarrhea – Dilated pupils – Goosebumps – Nausea – Vomiting

Medications Used When Tapering off Opioids

Several medications can be used to help you stay off opioids. These can help minimize withdrawal symptoms and cravings to give you a tool for success. For specific questions, contact your pharmacist or healthcare provider.

Methadone

Methadone can help reduce cravings and is often used during detox. Often used long-term, most people taper doses down slowly and may remain on methadone for several months or several years.

Buprenorphine

Buprenorphine is available in many formulations, and, like methadone, buprenorphine reduces cravings. Also, like methadone, buprenorphine is often used during medical detox and can shorten this process. Sometimes it is used long-term for maintenance.

Sublocade

If you have taken buprenorphine for at least seven days, then Sublocade may be an option. Sublocade is a long-acting injectable form of buprenorphine that your healthcare provider will administer monthly.

Narcan (Naloxone)

When naloxone is given intravenously (IV) or intranasally, it works as a reversal agent for opiates and would only be used as a rescue medication to prevent an opioid overdose. If taken during detox, naloxone can cause sudden, severe withdrawal. However, when combined with other medications, like buprenorphine, naloxone can prevent misuse because it is inactivated in the stomach.

Suboxone

Suboxone is a combination product containing buprenorphine and naloxone. This combines buprenorphine’s ability to reduce cravings with naloxone’s ability to prevent misuse.

Naltrexone

Naltrexone is only used after detox because it can cause sudden, severe withdrawal if you still have opiates in your system. However, it can help to prevent relapse.

Vivitrol

Vivitrol is a long-acting injectable form of naltrexone administered monthly.

Can Tapering Your Opioid Intake Reduce Withdrawal Symptoms?

Tapering your opioid dose is one strategy to stop opioids. You may experience withdrawal symptoms if you taper your dose down too quickly, so it is best to discuss wanting to stop opioids with your healthcare provider. In most cases, stopping opioids is most successful if done under direct medical supervision.

How The Recovery Village Uses Opioid Tapering

At The Recovery Village, we customize your care to ensure you have the highest chance of success. Depending on your unique situation, our compassionate providers may recommend medical detox or opioid tapering. In addition, we offer a full range of care, including medical detox, partial hospitalization programs, intensive outpatient care and even telehealth. Contact us today to begin your journey.