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How Do You Taper Off Opioids?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Apr 26, 2023 • 6 cited sources
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To taper off opioids, you’ll gradually reduce your dose over a period of weeks to months. A doctor should design your tapering schedule, instructing you on the dosage to take each week.

Opioids are prescription painkillers, and in 2017, more than 191 million prescriptions for them were dispensed to American patients.[1] You should only take them for a few days. Use them longer, and you could develop physical dependence. After you start taking opioids longer term, quitting them suddenly could make you sick. 

Tapering off opioids is a safe, supervised way to stop taking medications. Your doctor can choose from one of two plans: fast or slow. Both can be somewhat uncomfortable, but they end with you not taking painkillers. 

Why Should You Consider an Opioid Taper?

Experts say everyone should consider an opioid taper if they’ve used the medication continuously for more than a few days.[2] The stronger your dose and the longer you’ve used opioids, the more urgently you need to taper. 

Using opioids changes brain chemistry. Cells pump out large amounts of dopamine with each dose, and over time, they won’t create this neurotransmitter as easily without the pills. Doctors call this physical dependence, meaning your body doesn’t work properly unless drugs are in your system. 

Experts say physical dependence can develop after using opioids for as little as five days.[3] The longer you use opioids and the higher the dose, the deeper the dependence. 

Physical dependence is not the same as addiction. People dependent on drugs may not have destructive habits, such as these:

  • Stealing money to spend on drugs
  • Buying drugs from street dealers
  • Taking large doses of drugs for euphoria 
  • Hiding their drug use 
  • Mixing substances in search of a better high

But physical dependence can transition into addiction if you don’t taper and stop taking opioids. Getting help early is critical.

Some people decide that a taper is right for them and talk to their doctors. Others choose to taper because their doctors recommend it due to the following factors:[4]

  • Your pain isn’t improving despite the pills.
  • You’re struggling to control your opioid use.
  • You’ve had at least one overdose episode.

If your doctor recommends a taper, you must comply. Some doctors will stop authorizing refills for people who will not follow tapering orders. 

How to Taper Off Opioids

Your doctor can help you determine a tapering plan that’s right for you based on your opioid history, health, and preferences. Two main taper options exist. 

Fast Taper 

Sometimes, it’s not safe to reduce your opioid dose slowly. Your doctor might recommend a fast taper if you have some attribute that makes a slow taper risky.

A rapid taper involves reducing your dose up to 50% right away and then doses are lowered up to 20% every day.[5] 

If you’re taking an extended-release, high-dose opioid, your doctor might switch you to a weaker version that wears off faster. Then, your doctor might recommend smaller doses of pills on a schedule that gets you off the medication as quickly as possible. 

Fast tapers like this can be uncomfortable. Your brain doesn’t have time to adjust to a lack of drugs, so you’ll have an intense desire to simply use again to make the discomfort go away. You might need close monitoring to ensure you don’t relapse to drugs during this process. 

Slow Taper

A slow taper allows your brain to adjust to sobriety. If you’ve been using drugs for a short time, and you don’t have symptoms of opioid use disorder quite yet, this could be a good approach for you. 

During a slow taper, doctors decrease your dose by about 5 to 20% per month.[4] You could tackle this process at home with close instructions from your doctor. At some point, you might need to switch medications to allow the dose to get smaller and smaller. 

Can You Taper Off Opioids Without Withdrawal?

Opioid dependence causes physical symptoms when you quit using opioids abruptly. Those uncomfortable symptoms are called withdrawal. During a very slow taper, you may not experience withdrawal symptoms, but you might experience mild or moderate difficulties during faster tapers. 

Withdrawal symptoms can include the following:

  • Sweating
  • Aching muscles
  • Watering eyes 
  • Diarrhea 
  • Nausea 
  • Sleep issues

Doctors can monitor your symptoms and their severity. If your problems are severe, your taper might be moving too quickly and the plans might need modification. 

In most cases, it’s normal to feel at least a little uncomfortable during a taper. Very few people move through it while feeling perfectly fine. 

Generally, the symptoms are most intense in the beginning stages, and they begin to dissipate with time. Make sure to communicate with your doctor along the way to ensure you make it through the process safely.

Benefits of a Medically Supervised Taper

It’s never smart to quit opioids cold turkey. Experts say quitting cold turkey can lead to stronger cravings and continued drug use.[6] A supervised taper managed by a doctor is much safer. 

Your doctor can create a taper plan and supervise the process. If you develop significant withdrawal symptoms, you can either slow the taper or try a different technique. 

Medication for Addiction Treatment (MAT) programs involve using therapies like buprenorphine (Suboxone) or methadone. These medications work directly on receptors changed by drug misuse. 

When you’re taking the medications in place, you don’t experience withdrawal symptoms or drug cravings. These medications are often critical for people with advanced drug dependence or opioid use disorder. 

When you stop using MAT, you may need to taper your dose instead of quitting cold turkey. Some people opt to keep taking their medications for a lifetime to avoid a complicated withdrawal and to support their continued recovery. 

Talk with your doctor about how to taper your opioid dose. And if you’ve tried to taper and can’t do it, talk about whether MAT is right for you.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

Sources
  1. Prescription Opioids. Centers for Disease Control and Prevention. https://www.cdc.gov/opioids/basics/prescribed.html. August 2017. Accessed March 2023.
  2. Prescribing Opioids for Pain: The New CDC Clinical Practice Guideline. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMp2211040. December 2022. Accessed March 2023.
  3. Opioid Dependence Can Happen After Just 5 Days. Truth Initiative. https://truthinitiative.org/research-resources/substance-use/opioid-dependence-can-happen-after-just-5-days. October 2018. Accessed March 2023.
  4. Pocket Guide: Tapering Opioids for Chronic Pain. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf. Accessed March 2023.
  5. Opioid Taper Decision Tool. U.S. Department of Veterans Affairs. https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Pain_Opioid_Taper_Tool_IB_10_939_P96820.pdf. October 2016. Accessed March 2023.
  6. Opioid Abuse. American Society of Anesthesiologists. https://www.asahq.org/madeforthismoment/pain-management/opioid-treatment/opioid-abuse/. Accessed March 2023.
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