Opioids are useful medications when it comes to treating pain. They mimic your body’s own pain-relieving chemicals and use naturally occurring opioid receptors to block moderate to severe pain. However, opioids are potent and can lead to chemical dependency and addiction. If you’ve been taking an opioid for a while and you notice some of the signs of dependence, like flu-like symptoms or cravings when you try to cut back, you may need to speak to your doctor about tapering.
Tapering off opioids is a good option for people with some level of substance use disorder that involves chemical dependence. When you notice the signs, your doctor may be able to help you form a tapering schedule to help your body return to a normal chemical balance without going through severe withdrawal symptoms.
Tapering is a delicate process though, and you are more likely to prolong uncomfortable symptoms or just continue using opioids if you try to stop the Centers for Disease Control and Prevention recommends that tapering plans should follow four main principles:
Tapering is a tricky process that requires medical help because it involves striking a balance between reducing your dose enough to cause your body to adapt to smaller doses, but slow enough so as not to cause severe withdrawal symptoms. However, the CDC recommends that doctors should err on the side of caution by tapering slowly.
Detoxing too fast can just prolong uncomfortable symptoms or withdrawal, rather than easing withdrawal symptoms. The CDC recommends that doctors of patients in long-term opioid treatment should start by decreasing their patient’s opioid dose by 10 percent each month. Patients that have only used opioids in the short term may be able to handle a more aggressive tapering period of 10 percent each week.
Many types of doctors need to be able to manage a patient’s pain symptoms, but they aren’t all trained in managing tapering periods. Some hospitals have teams dedicated to pain management, which includes weaning off of a drug when a patient no longer needs it. Other medical professionals that are experienced in detox or that work in addiction treatment may also be specially trained or experienced in managing tapering periods. If you’re chemically dependent and your seeking medical help in tapering, speak to a specialist or ask your doctor about tapering consultants.
Withdrawal doesn’t just affect the body. Opioid withdrawal symptoms often include anxiety, depression, and powerful compulsions to use the drug again. Addiction can come with its own mental symptoms like shame, apathy, and hopelessness. The CDC recommends that doctors make sure patients have psychosocial support through mental health providers or addiction treatment specialists.
The CDC also recommends that doctors encourage patients along the way. Tapering and detox can be challenging. Your pain symptoms might increase at first, and you might experience some opioid withdrawal symptoms like body aches and nausea. However, pain symptoms often improve after you complete your taper. Encouragement may seem like an unimportant part of treatment, but listening to it may improve what doctors call “patient buy-in,” which refers to your belief that the treatment can work. A positive outlook can help you get through the uncomfortable parts of your taper without becoming discouraged.
American Psychiatric Association. (2017, January). What Is Addiction? Retrieved from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
CDC. (n.d.). Pocket Guide: Tapering Opioids for Chronic Pain. Retrieved from https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf
National Institute on Drug Abuse. (2016, February). 8: Medical detoxification. Retrieved from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification
National Institute on Drug Abuse. (n.d.). Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids
National Institute of Mental Health. (2019, February). Major Depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml