The “Art” Of Opiate Tapering

How To Taper From Opiates: A Proven Strategy For Withdrawal Relief

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.

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 from opiates 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.

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”

Taper from opiates memory management device

High altitude climbers must go slowly in order to make sure they adjust to the altitude. If they climb too fast, they can become ill or even die. Tapering from opiates requires the same level of slow and steady progress.

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 from opiates. 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

(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:

Tapering From Opiates pill box

Pill Schedule Containers Like This One Are Perfect For Keeping Daily Doses Organized

Tapering From Opiates: 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
    • 12pm: 1 pill
    • 4pm: 2 pills
    • 8pm: 1 pill
    • Before Bed: 2 pills

Tapering From Opiates: 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.

Tapering From Opiates: 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
        • 12pm: 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

 

Tapering From Opiates: 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

 

Tapering From Opiates: 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 withdrawal 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.

Conclusion

I hope that this has been helpful as you plan your tapering schedule. Remember this is just a framework for tapering; 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 and following our Withdrawal Survival Guide, 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

Originally published in February of 2013

Edited: 6.5.16