The “Art” Of Opiate Tapering

george-portraitBy George Catlin, CEO of Withdrawal Ease

Tapering from opiates is one of the most critical strategies you can use to reduce the discomfort of opiate withdrawal. As I’m sure you can imagine, I get a lot of emails. I get emails from a multitude of folks from every state, every profession and demographic.

In fact I get some emails that range from the simple “Does it work?” to the sublime “THE ROOFTOP IS LATE ON THE SALAD!”

However -without question- the one subject that is far and away the most popular is “How should I taper from my opiates?” I probably could have saved myself and others countless hours of typing if I had gotten a clue and just written a little primer on how to taper from your opiates that I’ve learned from other people, doctors and various other resources. I’ll attempt to distill all of this learning into functional tactics that will hopefully help you taper from opiates as comfortably as possible.

First a disclaimer: There are a lot of you out there who are on all sorts of different drugs, potions and cocktails of every size and strength. This is one reason why I do not give personal recommendations to individuals about clinical matters. All that I hope to accomplish in this post is to relay some lessons that I’ve learned about general concepts of tapering that work.  I will go through an exercise where I put together a “mock taper” schedule but that is by no means a schedule for everyone. I am simply trying to illustrate how a taper program might play out. As always, if you have questions or concerns, ask your doctor. If possible always taper under the care of a licensed physician that knows your medications and your specific health issues. Again, these are just fundamental “guard rails” with which to taper by. Be safe and smart….

Ok, lets get started.

The Art of Tapering from Opiates

The Goal:

The general goal of tapering is to lower the amount of opiates or medication in your bloodstream and more specifically the amount of occupied opiate receptors in your brain so that you can reduce the impact of your withdrawal symptoms. It is imperative to keep in mind that immediately stopping some drugs can be potentially harmful. As a general rule, it is never wise to completely stop any medication abruptly unless you are advised to do so by a physician. If you reduce the amount of narcotics in your system; your withdrawal will hopefully be less severe and possibly imperceptible. That’s the goal..the hope. If you plan to detox, most physicians (and the data that I’ve read) suggest that tapering is an effective way to lower the acuity of your withdrawal symptoms. Like anything, sometimes this works and sometimes it doesn’t.

Note to Withdrawal-Ease Customers: If you are using Withdrawal-Ease, we have seen the best outcomes when our customers begin to take the Day Time and Night Time formulations approximately a 5-7 days before beginning your detox. This will allow the various ingredients in the system to get into your bloodstream and begin to work. Although it is not essential to follow this strategy, this is where we have witnessed the best results. Many people have started their Withdrawal-Ease upon detox (“Detox” in this case meaning the complete cessation of opiates) or even when they are in withdrawal and they have seen benefits. However, if possible we recommend starting Withdrawal-Ease prior to your withdrawal.

The Strategy:

The strategy for a successful taper is one that depends largely on the “Half-Life” of the drug that you are taking and your own body’s reaction to reduced amounts of opiates/narcotics in your body. In general terms, the Half-Life is the amount of time it takes for the opiate/narcotic levels in your blood to reach 50% of their original blood concentration. The half-life of your drug can vary from a few hours in the case of a drug like Heroin to 5 days for a drug like Suboxone.

The half-life of a drug usually coincides with the onset of withdrawal. So if you are taking Heroin intravenously, one can reasonably presume that with a half life of say: 6 hours, that one will begin to feel withdrawal symptoms after 6 or 7 seven hours or thereabouts. For a person taking Suboxone, which has a very long half-life it can take up to a week to feel withdrawal symptoms. As I mentioned, this can all vary from person to person based on your physical make-up; but the half-life of a drug is a very good indication of how long it will take for withdrawals to start after stopping or significantly reducing the intake of your medication. Ok, so I’ve beaten that one to death. Back to the strategy.

In my judgment, a successful taper is like walking on a razor’s edge. You are literally trying to keep two opposing forces at bay. On one side, you are trying to reduce the amount of opiates (or narcotics) in your bloodstream and on the other side you are trying to keep withdrawal from setting in. I cannot tell you how many people email me and say, “I’ve been tapering and going down from this to that etc. etc. and I feel awful.” My response to that is “Why?” The goal of tapering is to eventually Reduce the symptoms of withdrawal. The reason why you are lowering your dose is to help you feel better, not worse. Clearly, these people are not tapering their dose correctly. Either they are waiting too long between doses or they have reduced their doses too much too soon. Some people may disagree with me (for reasons I know not) but if you are tapering and you are acutely symptomatic then you aren’t doing it correctly. Of course there may be some very slight symptoms but one shouldn’t be in full-blown, goose-flesh withdrawal while tapering. Why prolong the agony? You are going to go through some sort of withdrawal/detox regardless.

The strategy should be to lower your dose as much as you can yet still remain reasonably comfortable so that your eventual withdrawal is as painless as possible. This may take some trial and error but the secret is patience and also a willingness to adjust your taper schedule if necessary. If you are sticking to a schedule and you feel sick then you may need to shorten the time between doses or possibly raise your individual dose just a bit so that you do not cause withdrawal symptoms. It’s a delicate balance for sure.

No one knows this more than a person trying to detox off of Suboxone. The difficult part of Suboxone is that is has a very long half life and people’s opiate receptors are not able to shed Suboxone very easily. For those people on suboxone, it can take months to taper properly and some people even get down to 1/4mg or less yet still find it very difficult to stop. There’s a psychological aspect to the PAWS (Post Acute Withdrawal) phenomenon for sure but everyone that I talk to on Suboxone or trying to taper off Suboxone has the same story: it takes a long time to get off of Sub. BUT it can be done. I address suboxone detox in the Suboxone Information section on the website

The “Mountaineering Memory Management Device”

Tapering from opiates is a useful strategy to help reduce the discomfort of your detox/withdrawal but it has to be done correctly or it can make matters worse. A good analogy would be high-altitude mountaineering. All climbers have to acclimatize themselves to the altitude or they can get sick and possibly even die from pulmonary edema or other nasty things that can happen suddenly and kill you. If you have ever read anything on climbing Everest or any tall mountains, you’ll recall that all climbers have base camps at several altitudes on the mountain. When they arrive at base camp #1, they may ascend up to Camp #2 and then come back down for a day or so. Then they gradually move up to each base camp going back and forth as needed so that their body can get used to the lack of oxygen at those higher altitudes. Tapering is essentially the same process. But mountain climbers don’t wait until they have a brain hemorrhage or pulmonary edema to go back down the mountain unless they have made a grave mistake and have acclimatized too fast. I think that this is a great example -albeit less grave- of what your strategy should be for tapering. Take it slowly and let your body get used to not being on as much medication; if you start to feel sick then maybe you need to slow down or maybe you’ve cut your dose by too much.

An Example of a Typical Opiate Withdrawal Taper With Withdrawal-Ease (Remember my disclaimer?):

Lets say that you are currently taking 10 Vicodin per day (2 at 4-6 hour intervals). You and your doctor have decided that it’s time for you to get off the pain meds. So you both put a schedule together and it goes something like this:

Week 1: Lower your dose to 8 per day but instead of skipping an entire dose just take 1 pill at two of your scheduled intervals. This should always be the strategy; you want to make sure in the beginning of your taper that your body/brain get  medication at the same times that they are accustomed to…just less of it.

8am: 2 pills

12: 1 pill

4: 2 pills

8: 1 pill:

Before Bed: 2 pills

Week 2: Lower Dose to 6 per day and keep a close eye on how you feel. Is your energy ok? Are you eating and sleeping well? Are you depressed? If you have any symptoms of withdrawal, you and your doc may consider raising your intake to 7 per day for the first half of the week. Remember, same intervals, reduce the dose.

Week 3: Lower your dose to 4-5 per day and cut out one interval. This will be a bit difficult but I have found that it easiest to take out one of the intervals in the middle of the day as opposed to the morning or night time doses. As always, inform your doctor if you are experiencing any acute symptoms.

8am: Take 2 pills

12am: Take 1 pill

4pm: Skip interval

8pm: Take 1 pill (If you are feeling ok at this point, you can try and quit this interval too)

Before Bed: 1 pill

Week 4: Cut Dose to 2-3 per day. This is the point where you take out another interval and begin to lengthen the time between doses.  As always, if you feel very sick or start to go into acute withdrawal, you will want to consider taking a pill as needed to relieve the withdrawal symptoms. Remember, the goal is to not feel acute withdrawals…but it’s not to get “high” either! Those days are gone.

8am: Take 1 pill

2pm: Take 1 pill

Before bed: Take 1 pill

Week 5: 2 pills per day.

For our Withdrawal-Ease customers, we would typically recommend that you start taking Withdrawal-Ease at this point.

Take one of your pills in the evening and one at night until the end of the week preferably Thursday. Thursday before bed should be your last dose. This is the time that we all dread but has to happen. It’s DETOX TIME! With any luck, your tapering program went very well, you stuck to your schedule by and large and your withdrawal symptoms will hopefully be mild. However, this will be the first time that your body and your brain will truly be without opiates. The vast majority of people who have been on pain medications for an extended period of time (more than 6-8 weeks) will go through some sort of withdrawal or detox. You will feel like you have the flu and you may have many of the symptoms that we describe on our symptoms page. Thursday is a good day to quit if you are on a regular work week, your acute detox process can be dealt with mostly on the weekend…or at least the worst part of it.

Hopefully, at this point you have been able to taper successfully and your symptoms will be mild. If you have been on opiates for a long time, the detox may still be very uncomfortable but at least you have done everything that you could to ease the symptoms.  You should also refer to our Withdrawal Survival Guide that takes you through the first 5 days of acute detox and will give you tips on what to eat, what to wear and how to plan your first few days of withdrawal.

I’ll be honest, a lot of people can’t make it through a taper process because it requires a lot of discipline. But it’s well worth the effort. You really need to concentrate on the end goal which is to get off of your medications and become symptom free, then you’ll be able to see the light at the end of the tunnel and start to feel better again. If you cannot taper no matter how hard you try, I would recommend getting your “pharmacist” who can help you stay on track with your taper schedule. This person is not necessarily a pharmacist rather, it is someone whom you can trust and will keep your pill supply for you and dispense them according to your schedule. This will prevent any “cheating” that may have sidetracked your tapering before. We discuss the “pharmacist” strategy in detail in the Survival Guide.

For our Withdrawal-Ease customers, you should take the Withdrawal-Ease throughout the detox period as described above and then take it as long as you feel it is helping you. If you feel like it is no longer needed then it’s ok to stop. One order contains a month’s supply of the Day Time Formulation and month’s supply of the Night Time formulation so that should be enough for the non-Suboxone customers out there. We’ve heard of a lot of people who take it until the supply is gone and then they’re done. Our Suboxone customers tend to take it longer due to the extended withdrawal periods that Suboxone causes. For ongoing wellness and help with any post acute withdrawal symptoms, we also have a product called Recovery Ease which has a Day and Night formulation and serves as more of a multivitamin for long term detox from opiates.

Conclusion:

I hope that this has been helpful as you plan your tapering schedule. Remember this is just a framework and not a prescription. Together with your clinician preferably, perhaps you can follow this same framework and reduce the discomfort of your detox from opiates. It’s one of the main hurdles that is keeping you from living a happy life and also gaining back the true “you.” Don’t let the fear of withdrawal keep you from gaining your life back; there’s a way to go through detox on YOUR terms and that makes a critical difference in how it impacts you and those that love you. As always, I will say that with a good taper program, following our Withdrawal Survival Guide and taking Withdrawal-Ease as directed, I believe that you will be FAR better off than simply going cold turkey. I think if you follow some of these processes, you’ll feel better and have a greater chance for success. That’s all that anyone can hope for. Tapering works and quitting is worth it.

Thanks,

-George

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  • melinda

    Hi George, I forgot to tell you that I take Ativan, 2 mg every night for 5 years now for anxiety and sleep issues. Can these help me with quitting my Subutex for good? thank you so much for your advice, it is very much appreciated, I have no one to talk to about this! God Bless you! THANK YOU!!

  • Ashamed

    This site gives me so much HOPE. I am scared b/c I don’t get scripts from a doctor. My mother was dying and I was her care taker. I was recovering from drug addiction until my mom became my responsibility and w/a 4 year old daughter to take care of as well. I am down to one pill. A 30mg morphine. I tapered from 90mg so far. Yes, I do wake up around 5:00 am lately and need to take 30. My cousin is going to help me out with his meds until I can taper down more to the “jump off” point. I went through WD’s before many, many years ago and I am scared to death and very ashamed I put myself in this situation. My mother is w/the Lord now and it’s time to deal w/my sin. It helped me take care of EVERYTHING before, but now (even then) I need to do life on life’s term. My cousin has 15mg and I have no idea how many he will give me. I am SO determined to quit and as George said “get me back”. A happier person. I know 15mg most likely will not be enough, but I am in a situation that I have no choice. Whatever my cousin gives me is most likely all I will have to help. I’m praying for God’s mercy and grace. God bless you all and we can do this! Open to suggestions. TY all for your comments and for George and all his energy put forth to help other’s. God bless you George.

  • Mark Smith (Not real name)

    I have a recommendation…. post taper spreadsheets – each one a function of beginning daily dose (e.g. 90 mg vicodin/day, etc.). Then have successful people fill in the tapering schedule they followed and then average the results with a listed standard deviation +=- 2 days or mg/day etc. This would be invaluable information and usable as a credible resource to physicians? Just sayin…

    • https://withdrawal-ease.com George

      Hi Mark. You’re on the right track there. In fact, we are working on a “Tapering App” that will use standard tapering rates based on dose and medication to put together a personalized tapering plan. It will be able to give reminders, keep people on track and have a lot of other functionality. I think it’s going to be a valuable tool for our visitors and customers. Stay tuned.

  • Dennis

    I want to quit cool terky ones I get your product I want to stop my 5 a day vicodine habit, how bad will you say it will be my symptoms, please help I only have 30 days left out of work please if you can email me back I don’t know if I be able to find the answer here please..

    • https://withdrawal-ease.com George

      Hi Dennis. I’m so sorry for the delayed response! I’m WAY behind on my responses to comments…the Korean Spam is outflanking the Russian spam now and it’s a mess for all who preside over comments such as yours. If you can taper and cut that Vicodin to about 2 or 1 per day then that would be great. Take the advice in our Withdrawal Survival Guide and I think you’ll be just fine…truly.

  • joe

    Hello George – I am a total mess. Right now. I am on 150 mg Fentanyl patches (1-100, 1-50) every 48 hrs. They stay active for 72 hours so I don’t switch them out right away leading confusion to my exact starting point. So, it’s hard for me to have a starting point. I always feel bad discarding a patch that still has some medication in it. My doctor writes it this way because when I sweat, it sometimes falls off before 72 hours. I have a prescription for up to 12 – 30mg Roxy oxycodone for break through pain. Not mistype (360 mg per day). This has been going on about 7 years. My wife is willing to help in any way. I have a 10 year old boy and do not want to be away from him. How would you suggest my starting point? Is there a percentage cut-down ratio? Thank you so much, I look forward to your response.

    • https://withdrawal-ease.com George

      Hi Joe. Thanks for the post and I know it must feel a bit claustrophobic to be so reliant on a medication. Your intake of Roxycodone is “impressive” I must admit. All told, you’re taking a significant amount of painkillers which leads me to my question: why are you in so much pain and if you are, why are you stopping your meds? I’m not suggesting that you shouldn’t stop but it seems to me that your doctor knows exactly what you are taking and for all intents and purposes it sounds like he is satisfied with the results? I may be making some assumptions here but I certainly do not want to try and convince someone to stop taking a medication that they may need. Opiates are great painkillers and if you have serious pain, there really is no substitute for them. Nevertheless, as I mentioned, your intake is significant so it is a concern for a young man like yourself.

      Based on the extent of your intake and your obvious pain issues, I’m honestly not sure if a home detox should be in the cards for you. Certainly Withdrawal Ease could help if you decide to detox but again, there seem to be a lot of factors at play here and I’d be irresponsible if I suggested that an order of Withdrawal Ease was your easy ticket to freedom. I think it would be best to discuss this with your doctor since he knows exactly what you are taking; he may have a suggestion as to how to detox you without subjecting you to a lot of pain.

  • Jonathan

    Dear George, I am glad to see someone as yourself interested in helping others to ease through their escape. The back story to my struggle began in 1972, when I was 17. I lived with my sister who was 29. A severe accident occurred in front of our house. The wreck was so bad that both of us were severely cut up from the broken glass and twisted metal as we provided lifesaving assistance. Within a few years we both developed symptoms that were later diagnosed as Hep “c” in the late 80’s. Before that it was non “A” or “B”, and prior was thought to be mono. By the time we found out what this was much physical damage was done to our bodies. My sister died in 2002 and I am still going strong with stage 4 liver disease. We were both on high doses of pain pills and I have detoxed many times. Each time gets harder. I have had 5 surgeries between 1994 and Jan. 2015. That’s the reason I have gone through this so many times, but now I have been on 3ea.@ 60mg morphine sulf. tabs. E.R. since 2009. I began a disability at that time. My ability to provide myself with a livable income has been reduced to a shameful monthly allowance. I find myself having to ask for charity even though most of my life was spent helping others, mostly in the ministry. I was active since 1984 and even went to S. America in 2011 to help the indigenous people of the Amazon River Basin”. While I was there my teeth began to break. Before that I had a proud and motivating smile. My bones have become brittle and my blood vessels have become small and brittle. This January 29,2015, my gall bladder was removed. So I am trying again to detox, which is how I came across your website. I am in constant pain. I suffer with spinal stenosis and had a disc-ectomy in 1999, but the arthritis has returned and now involves the entire neck and back. The bursa on my right shoulder needs to be corrected surgically. I am cured now of the Hep. “C” after failing the first round in 2009 for a years worth of treatment. I began with a new drug in March of 2014 and was cleared after 3 months of treatment and after a 6 month follow up. My liver functions are all normal even though I am in early cirrhosis the prognosis is good. I want to return to my mission and have been asked to come to S.E. Asia. My benefits pay all of the medical and most of the prescriptions, but the dental is way more than I can pay for. I have a terrible, shameful smile, it breaks my heart. I was told all these health complications are secondary to the Hepatitis and taking prolonged high doses of pain meds. has accelerated things. I’ve decided to be free of these narcotics when I go to Asia in the fall. The shoulder surgery is considered one of the most painful so I am down to 1 half tab in the morning and the same at night of the morphine 60 mg.,e.r. but I am at a plateau. I’m hopeful not to require such high levels of pain mgt. following the surgery. Then I have to stop again. I need advise and possible a bit of charity if I can’t do this without some help from the herbal remedy, “Withdrawal Ease”.
    You might ask why get off the pain meds if you still have chronic pain issues. The answer is I have learned to manage without narcotics by reducing the pain distraction through other methods, such as exercise and and diet.
    I’m a fighter at 60, but I have a calling I cannot ignore, it is bigger than me. Thank you so much for reading this and sharing the Hep. “C” story, for there is new hope for those who suffer with resistant genoe types.
    God bless

    • https://withdrawal-ease.com George

      Dear Jonathan. I don’t know what to say other than your struggle puts everything is perspective for me personally. Good health is always taken for granted and although your journey has been extraordinary, I think it should resonate with everyone who reads your story. If there is any way that I can help please let me know. I would certainly be pleased to offer you a free order of Withdrawal Ease if you wish. I know that you wrote this post a while ago and I’m sorry that I had not read it until now. I have over 200 blog posts, each with comment strings which is difficult to keep up with. Nevertheless, I wish you well Jonathan, I hope that your luck turns because you certainly have gotten your fair share of bad luck and tough breaks!

  • Phil

    Folks, Withdraw Ease does work wonders. I went through the detox process in Nov. 2014 after being on Norco for 10 years. After my surgery I decided to clean up and stop taking the meds even though I continued to have back/neck pain. I followed the instructions and I admit it wasn’t easy as I went through depression, chills and few other symptoms. After the 4-5 day I was feeling much better. The end result was after a couple weeks I felt new again. 10 years it took me to feel human again. The only drawback is I had another surgery in March which was very painful and I returned to taking my meds. I’m only at 3-4 a day but it’s time to use Withdraw Ease again to get back to normal. No doubt about it, I’m scared and not looking forward to the detox, but knowing the product works and helps relieve the hard core symptoms, I’m forwarding my experience to the rest of you who hope to get off of painkillers and get back to your life. Honestly, I was happier, more energy and felt like doing normal things life has to offer after using the product and getting off the meds. This includes muscle relaxers. I rather suffer with minor discomfort then being addicted to painkillers again. Good luck!!

  • Donna Neuman

    Sorry for the typos I am just crying and desparate for help. I can’t even text properly anymore. I can’t organize my house as we just moved up for the downstairs basement and my ex thinks I’m fine to remodel the basement on my own. Little does he know I’m drug dependent and can’t even find my electric bill. This crap has me in such a fog I can’t do daily simple things and pretend to be fine but everyone asks if I’m okay. Its obvious I’m not myself. I am moody and also in menopause and this alone has been hell. Put menopause along with opiate addiction and its the perfect storm. As a mom and a career woman I never dreamed my husband would leave and now I have to run the house on my own. He says well go back to work ! Fix the apartment and rent it! I have two kids 6 and 8 and I a so busy with them I have no time . I just keep taking these stupid pills to get through the day and I don’t need to be on them anymore. I am sorry for writing so much but I came across your site and its the first time I feel hope that Incan do this but as I said I am broke and can’t afford it so I am humbly asking for a helping hand and I promise to pay it back and forward. I want to start ASAP. Today I am begining my tapering and hope I can get your product as i can’t function with the teribble withdrawals. I have a pill box that will help me taper and keep track of when to take my doses. I know I won’t feel good so Inwant to have my sons at dads when I get off and go through the detox time. I have tried to speak to my doctor and she just wants to cut it all in half so I said no. I will taper myself without her help. I can do this but I know I need your help and product . When I read how so many have gotten off these pills with your help I am so happy. God bless you and your product and I want to get on this next week ASAP. I pray you call me as I emailed my phone number to you or at least respond. I called and left a message as well. Sorry I am so ready to start and need to be back in my life again. Thanks for this site!

  • consuela

    Thanks for this website, it gives me hope. I tried to do this on my on and I’m failing. My grandaughter birthday party is this weekend and I hope I have my withdrawal ease by then because I’m not physically able to do anything right now. I can’t even stand myself right now for letting this happen to me. I just want my life back. I’m a good Nana and my grandbaby is depending on me to be at her 3rd birthday party but I can’t go not like this, I’m sick ad a dog til I just wanna die. I Never Imagined I Would Ever Go Through Anything Like this. I’m just about to lose my mind. This is tough. I wish everyone well and I pray we all make it through

  • Brian

    Way to go Donna! It isn’t easy reaching out a down deciding that it’s time to quit. I say this as a current opiate user for pain management (on a high dose), and relate to the fog/irritability you mentioned. I also think that you can do this with or without the product (‘withdrawal ease’) if you’re truly ready to quit. I can speak from experience in saying that I hesitate in quitting because of the fear of withdrawal. As mentioned, I think it comes down to willingness and if you can admit that you’re truly through with opiates, then you’re ready. Like people who quit problematic drinking, (without tapering, even though it’s more dangerous than opiate withdrawal ), it is possible. From easiest experience, the most important and challenging part is maintainace and support after you’ve quit.
    Again, thanks for the courage and honesty. I k kw you can do this with some help (from loved ones). Stay positive and don’t let the fear control you. Many people quit every day who are in the same boat or often worse off.
    Good luck!
    Brian

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