Tapering off opioids: When and how

When it's time to stop using opioid medicine

Opioids are powerful painkillers. But there are risks linked to opioid use — including severe constipation, nausea, dependence, misuse, opioid use disorder and accidental overdose. Still, opioids may be the best option at certain times. For example, opioid medicines may help when the pain level is very high and short term.

Your healthcare professional may prescribe opioids to help you get through a few days of severe pain after surgery or a serious injury. Opioid medicines also can play an important role in treating pain from cancer. Rarely, opioids may be used to treat long-term pain that's not caused by cancer when other treatments have not worked.

If you've taken opioids for less than 7 to 10 days, you should be able to simply stop these medicines as soon as you've finished the pills your healthcare professional ordered, if not before. Ask your healthcare team if you're not sure when you can stop your opioid medicine.

If you've taken opioids for more than 7 to 10 days, you may need to stop using these medicines to keep from having possible serious problems. It's time to stop taking opioids if you:

• Have no more need for pain medicine.
• Choose to try another pain relief treatment.
• Have serious side effects from taking the medicine.
• Have poor pain relief from the same dose of medicine over time.
• Behave in a way that causes concerns about opioid misuse or opioid use disorder.
• Take opioids for reasons other than pain control, such as to feel intense happiness and confidence, sometimes called a high, or to relax.

Symptoms of opioid use disorder include:

• Regularly taking more medicine than prescribed and needing early refills.
• Taking opioid medicine for reasons other than for pain, such as to improve mood.
• Asking for opioids from several healthcare professionals or getting opioids from other sources such as friends, family, the internet or illegal sellers.
• Having severe mood swings, for example, quickly changing from happy to angry.
• Losing interest in people and activities enjoyed before taking opioids.
• Behaving in risky ways that result in danger.
• Not being able or willing to stop using opioids despite the problems they cause.

Do not try to suddenly stop taking opioids on your own. Opioid withdrawal can be dangerous, and symptoms can be severe. When it's time for you to stop taking opioids, ask for your healthcare professional's help. Together you can create a plan to stop opioids slowly, called a taper. Tapering means slowly lowering over time the amount of opioid medicine you take until you stop completely.

How long it takes to taper off your medicine depends on the type and dose of the opioid you've been taking and how long you've been taking it. You may need weeks, months or even longer to slowly and safely lower your dose and stop taking your opioid medicine.

Stopping opioids can be difficult, but you can do it. You're much more likely to succeed if you partner with your healthcare team. Together you can plan your taper schedule and manage your symptoms. You also can learn other ways to cope with pain.

Not sure if your medication is considered an opioid?

Some examples of the many opioid medicines on the market today include:

• Hydrocodone (Hysingla ER).
• Hydrocodone-acetaminophen (Anexsia).
• Fentanyl (Actiq, Fentora).
• Oxycodone (OxyContin, Roxicodone, others).
• Oxycodone-acetaminophen (Percocet, Oxycet).
• Tramadol (Conzip).
• Morphine (MS Contin).

Ask your healthcare team if you're not sure whether your pain medicine is an opioid.

What a safe opioid taper involves

The right length for an opioid taper varies with each person and each medicine. Your healthcare professional works with you to create an opioid taper schedule that meets your medical needs while keeping risks to your health low.

During your opioid taper, your healthcare team may:

• Regularly monitor your symptoms of withdrawal, your pain level and your ability to do daily activities with a reduced dose of opioids.
• Request urine or blood samples to check the type and amount of opioid medicine or other substances in your body.
• Ask you if it's OK to talk with your other healthcare professionals, pharmacists or family members to get information that may help with your medicine taper.
• Offer other pain treatment options.
• Prescribe other types of medicines to help you manage withdrawal symptoms such as problems with sleep, appetite and mood.
• Recommend talk therapy with a mental health professional to help you manage symptoms and learn coping skills.

Follow your opioid taper plan closely. Especially follow your healthcare professional's instructions about how and when to take medicines during the taper.

You may be eager to reach your goal, but your body needs time to adjust to lower levels of opioids, and then to none at all. A step-by-step plan to lower how much opioid medicine you take will help this process go smoothly. This slow tapering also helps ease the discomfort you may feel as you stop taking opioids. During this time, you can practice new skills to manage pain and other long-term symptoms too.

You may be tempted to take more opioid medicine than your taper recommends. Do not start taking any opioids you have at home that you received from other health professionals or visits to the emergency room. Also, do not add alcohol or street drugs. Extra opioids, alcohol and drugs can increase your risk of an overdose.

Once your opioid taper starts and you're taking a lower dose of opioids, you start to have a lower tolerance to opioids. If you suddenly take a higher dose of opioids, you're at an increased risk of overdose.

If you feel the need to manage withdrawal symptoms, talk to your healthcare team right away.

Your healthcare professional may recommend that you have naloxone available to lower your risk of an overdose. An overdose could result in death. Naloxone reverses the effects of opioids during an emergency if you stop breathing. You don't need a prescription to get naloxone. Narcan and Revive are naloxone nasal sprays you can buy without a prescription. It's important that your family members know how to use naloxone.

Withdrawal symptoms

You may have withdrawal symptoms when you stop or lessen the use of opioid medicine. Symptoms may vary depending on several issues, such as the speed of the opioid taper and how long you've used opioid medicines. Tapering over time can help lessen withdrawal symptoms or keep you from having them.

Symptoms of opioid withdrawal may include:

• Runny nose, watery eyes and yawning.
• Restlessness or anxiety.
• Irritability or mood changes such as sadness and depression.
• Increased pain.
• Goose bumps on the skin, chills or sweating.
• Belly cramps.
• Nausea, vomiting or diarrhea.
• Muscle cramping or aches and joint pain.
• Shaking or muscle twitching.
• Fast heartbeat.
• Blood pressure changes.
• Trouble sleeping.
• Thoughts of suicide or suicidal behavior.

If you have withdrawal symptoms, tell your healthcare team right away. Follow all instructions about how to manage your withdrawal symptoms.

You also may find these tips helpful during your opioid taper:

• Drink more water or other liquids than usual, unless you have a medical reason to limit liquids.
• Eat regular, healthy meals.
• Use deep-breathing and stretching exercises.
• Get regular moderate physical activity, such as walking.
• Do something to relax — for example, practice relaxation techniques, get a massage, listen to music or read.
• Use distraction — for example, enjoy humor or talk with someone who has a positive outlook.
• Use positive self-talk — for example, tell yourself, "I can do this," or "This is only temporary."

The key role of social support

Talk with your healthcare team if the taper becomes difficult. Your care team can help you and encourage your success.

Your healthcare professional may recommend combining your taper with counseling from an alcohol and drug counselor. Counseling can help you learn ways to cope with stress, identify early warning signs of relapse and keep you from taking opioids. Your healthcare professional may recommend continued counseling after you've completed your opioid taper.

Opioids are addictive. If you find yourself having difficulty during your taper, support from others can be very helpful. If you and your healthcare professional think you have an opioid use disorder, voluntary groups such as Narcotics Anonymous are structured support groups. They are led by other people who have been dependent on addictive substances. These groups can be a powerful support network for those who find that they aren't able to quit using opioids despite their best efforts. Talking with your religious or spiritual advisor may help too.

Future use of pain medicine

Someday you may face a sudden, short-term health problem such as surgery or an injury. If an opioid is prescribed, let your healthcare team know if you had any trouble tapering off opioids in the past. If you've successfully tapered off opioid medicine in the past, taking opioids for a brief time — with guidance from your healthcare professional — may be OK. But ask about all nonopioid pain medicine options to treat your pain, including the benefits and risks.

Also ask about other ways to help manage your pain. A few examples are ice or heat therapy, physical therapy, massage, acupuncture, and nerve stimulation.