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10 Reasons to Consider an Opioid Taper and How to Do It

Drugs & Alcohol - Most Recent - Recovery
Written by: on 10th September, 2018

man planning opioid taperOpioid tapering is the method of dose reduction chosen by many to help prevent or reduce symptoms of withdrawal prior to entering treatment. Unfortunately, tapering doesn’t always provide a safe method of getting sober because for an addict, an all or nothing attitude generally persists beyond the will-power necessary to facilitate a proper opiate taper. In a medical setting, such as an inpatient detox center, safe and effective opioid tapering to reduce pesky withdrawal symptoms is possible.

Why Choose Opioid Tapering?

Healthcare professionals and patients that have completed an effective opioid taper agree that when this method is undergone in a controlled setting, the outcomes are a much more comfortable detox versus a rapid, cold-turkey detoxification. Your reasons for choosing to taper off an opioid such as Oxycodone or Morphine may vary, but for most, the end goal is the same: to be opiate-free and prepared for the next step in the recovery and healing process.

Below are the top 10 reasons to consider an opioid taper:

  1. Routinely taking high doses of opioids can lead to overdose and toxicity. Tapering can reduce the risk of fatal overdose. If the dose is above the prescribed limit, or the recommended limit, it may be time to taper.
  2. Analgesic therapy may not be achieved despite proper prescribing practices. Reducing the dose slowly can help patients to avoid withdrawal.
  3. Unacceptable risks, those risks that are not worth the small benefits of opioid therapy, may be a reason for a patient or physician to decide that opioid taper is the best method to eliminate opiate-therapy from the treatment regimen. Certain unacceptable risks include things like cognitive decline, sedation, or constipation.
  4. Upcoming surgery could cause a need to taper down to a lower opiate dose. Research suggests that chronic opioid therapy (COT) patients need up to 3 times more opiates following surgery compared to opiate naïve patients. Reducing the dose before surgery can help improve overall outcomes.
  5. The stigma of opiate use is too high and does not outweigh the benefits. This would be a psychological reason for a patient or an addict to taper their dose down but it is a common occurrence. Some find that once others know about their opiate use, they can’t deal with the stigma that is attached to their drug use and they would rather not be “looked down upon” for using opiates. As a result, they may taper off their dose to safely eliminate the drugs from daily use.
  6. Providers taper patients if there are issues with compliance. For instance, if you are in pain management but you are not submitting clean urine samples or you miss a pill count, your provider may decide to taper your dose off and no longer provide medication as you are showing signs of abuse.
  7. If you are using opiates for anything other than for pain, it may be time to taper the dose down and eliminate the opiate use altogether. Any use of opiates other than prescribed use is both potentially dangerous and could be considered a sign of abuse or addiction. Professional help with the taper and with subsequent treatment for addiction may be required in such cases.
  8. Benzodiazepines may be required for treatment of anxiety or similar mental illness. If benzos are required, tapering the opiate dose down to zero or to a very low dose for pain is often required before a benzo can be prescribed safely.
  9. Pain response after years or months of opiate use may be minimal. If a patient is no longer responding well to the opiates, it may be time to taper the dose down and see if adequate pain relief can be achieved on a lower dose.
  10. Hyperalgesia, a rare case of pain that results FROM opiates, may lead to a taper recommendation by a doctor. If you are experiencing more pain than when you don’t take an opiate, it could mean your body is rejecting the drugs and a taper could lead to better pain relief for you.

How to Taper Opiates Safely

Only a medical professional can safely taper your medication for you. Whether you take opiates with or without a prescription, the safest tapers are done under the direct supervision of a doctor or treatment specialist. Our directory lists many specialists that can assist with the taper process. You can also call 800-483-2193 for live support.

Tapering involves:

  • Reducing the opiate by 5-20% every few days or every few weeks depending on the speed of the taper, the patient’s health, and other factors. Rapid tapers can be completed in 7-14 days, slow tapers may take 6 months or longer depending on the starting dose.
  • Switching from a long-acting opiate formulation to a short-acting formulation. After this switch is made, the dose is lowered gradually as stated above. At the bottom end of a taper, the dose may be switched back to a long-acting medication per doctors’ instructions.
  • Monitoring withdrawal symptoms and adjusting the taper as needed. The COWS scale is used to monitor patient symptoms ranging from mild to moderate or severe. During a taper, withdrawal symptoms should NOT reach severe strength.
  • Educating patients as to the risks of overdose following a taper. After 1-2 weeks of an opiate taper, the patient loses tolerance to the previous dose of opiates. As such, overdose risks are heightened if the patient were to return to high levels of opiate use once again.

Although you should NOT attempt an opiate taper alone, there are some steps that most physicians and detox centers take in establishing a safe opiate taper for their patients. You can expect:

  • A very slow decrease in your medication unless a rapid taper is chosen. The CDC1 recommends a dose reduction of about 10% per week but faster tapers can be achieved in some cases.
  • Coordination with other specialists to ensure that you are receiving adequate psychological support during the taper. In residential detox, you may also have access to support groups to help you remain focused on the goal of zero opiate dose.
  • Access to alternative treatments or medications that can help reduce minor withdrawal symptoms which may be experienced during the taper. These symptoms can include diarrhea, upset stomach, or anxiety.
  • Ongoing support and mental health assistance for any symptoms of depression, anxiety or similar problems that arise during the taper. Often times, during the medication taper, is when someone realizes that he or she is addicted to the drug and needs further support.
  • Encouragement from your healthcare provider or professional. Most people have better function when they are tapered down slowly and are able to adjust to the lower dose of medication. Although you may feel a little bit under the weather during the taper, you will feel much better as your body adjusts.

Tapering in an Outpatient Detox

Physicians recommend tapering in a residential setting for those who are addicted or who are abusing medications as the risks associated with tapering and potentially relapsing are high. For those who are using medications as prescribed but are looking for ways to stop using the medications, an outpatient detox could be helpful.

Outpatient detox centers offer a wide range of supportive tools to those attempting an opiate taper. The emotional support and the professional assistance alone can make the process more efficient. Also, many centers can prescribe medications to prevent or reduce any unwanted symptoms of withdrawal that may spike through the reduced opiate dose. Medications may include:

  • Buprenorphine after the dose is reduced.
  • Suboxone or Subutex following the taper or a decision to abruptly end the taper.
  • Acamprosate to reduce symptoms.
  • Loperamide or other antidiarrheal medications.
  • Clonidine to reduce chills and similar symptoms of withdrawal.
  • Sleep medications to induce sleep when insomnia kicks in.
  • Anti-nausea medications for nausea and vomiting.

Only a professional can determine the best method of treatment for you whether an opiate taper is or is not the answer. If you are currently struggling with addiction or you know someone who is, now may be the time to get help. A safe opiate taper can be achieved with the help of a professional. Professionals are standing by at 800-483-2193.

Sources

[1] Centers for Disease Control and Prevention. (2017). Pocket Guide: Tapering Opioids for Chronic Pain.