When opioid use becomes concerning, it’s difficult to know where to turn. The thought of withdrawal symptoms is understandably worrying. Opioid tapering is a carefully planned, patient-focused process that allows people to reduce or eliminate opioids using a manageable plan.
Those who undergo opioid tapering benefit from continuous guidance that reduces their risk of relapse and other adverse effects. This post explores the importance of taking a safe approach to tapering, what to expect, and the types of support available.
What Is Opioid Tapering?
Opioid tapering is a process where a medical professional gradually reduces someone’s opioid pain medicines. The aim is to prevent or treat substance use disorders.
Tapering opioids is a delicate exercise that requires careful management from a healthcare professional, as patients who don’t receive the right guidance may experience withdrawal symptoms. It’s also important that people with chronic pain access alternative drugs that help them stay comfortable.
How Opioid Tapering Works
Opioid tapering requires careful management, including:
- Evaluation: Medical professionals review the patient, their current opioid use, and underlying health conditions. Patients with chronic pain require an assessment of their pain levels so doctors can identify alternative medications.
- Education: Doctors provide patients with information about the benefits of withdrawing from opioids and managing withdrawal symptoms.
- Plan: Each patient benefits from an opioid tapering plan. Typical ones include the patient’s current dose, the target dose (or complete withdrawal), and how slowly they will reach their target. Patients with chronic pain may find that their progress is gentle to minimize discomfort.
- Monitoring: Healthcare providers watch their patients closely during the tapering process. People who suffer from withdrawal symptoms or discomfort may find that their doctor adjusts their plan occasionally.
- Supportive care: Medical professionals often provide several forms of care, including counseling and alternative pain medications to help patients feel more comfortable.
- Psychological support: Withdrawal symptoms can often feel challenging, and counseling can help people build resilience. Therapy is also useful for patients who have an addiction, as it addresses the underlying reasons for their addictive behaviors.
- Maintenance: When the patient reaches their end goal, they may need help to stick to their target opioid doses. Or, they might require support to abstain from such medications altogether.
Pain Management Without Opioids
One of the most challenging aspects of opioid tapering is managing pain without opioids. This doesn’t apply to all patients, as some require long-term opioid therapy as a part of their disease management plan.
Some of the ways doctors manage pain without opioids include:
- Non-opioid medications: Drugs, including non-steroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and acetaminophen, are also useful for managing chronic pain.
- Alternative therapies: Approaches such as physiotherapy can target pain at its source. It’s useful for chronic pain that follows an injury.
- Targeting conditions: Sometimes, co-occurring diseases can make pain worse. For example, obesity can worsen joint pain. Addressing ongoing medical problems can alleviate pain and make opioid dose reductions easier.
- Medication-assisted treatment: Certain drugs can reduce withdrawal symptoms in those suffering from an opioid addiction. For example, methadone can lessen opioid cravings and is useful for pain management.
Stopping Opioids With Support
Patients who try opioid tapering are likely to experience some withdrawal symptoms. However, with the right support, it’s possible to minimize side effects and achieve the target dose reduction.
Methods of support include:
- Medical supervision: Healthcare professionals supervise patients throughout the tapering process. This allows them to manage severe withdrawal symptoms and make adjustments if necessary. Supervision is available with both inpatient and outpatient programs.
- Counseling and therapy: The emotional aspects of an opioid taper can become taxing. Continuous counseling and psychological therapies can reduce difficult emotional factors and make it easier for patients to stay on track.
- Patient education: Having a better understanding of how tapering works and the benefits can increase patient engagement. It also ensures patients have more faith in other pain management strategies. Education can also help family members provide support to their loved ones.
- Group therapies: Reducing opioids can sometimes feel like an isolating process, as patients may feel as though those around them don’t understand their struggle. Some people find that being among patients facing the same challenges helps them feel stronger. One study reveals how group interventions can significantly reduce the use of opioids in those not experiencing cancer pain.
- Case management: Some programs provide case managers who help patients address the social adverse effects of an opioid addiction. For example, they help people access housing, education, and legal services that provide stability.
When Is Opioid Tapering Used?
Two of the most common reasons to use opioid tapering include safely managing patients with chronic pain and stopping opioid dependence. However, there are other circumstances, too, such as complying with prescribing guidelines.
Preventing Addiction in Patients With Chronic Pain
Around 20.9% of US adults experience chronic pain. Of those, 22.1% use prescription opioids to manage their condition. Common reasons for prescribing opioids in these cases include back injuries, neuropathic pain, and arthritis.
Managing a patient’s pain is important for maintaining their quality of life. However, long-term opioid therapy can result in tolerance and dependence that outweigh the benefits of pain management. When this happens, opioid tapering is necessary.
Reducing a patient’s opioid dose and helping them use alternative pain management methods can improve their quality of life. This is particularly important for those who may need to use prescription drugs on a long-term basis, as they require a treatment method that offers long-term relief.
Treating Opioid Use Disorder
Some patients who take prescription opioids may develop an addiction, which is called opioid use disorder (OUD). Individuals who suffer from this condition experience pleasurable responses to using opioids and later rely on them to function.
When someone suffers from OUD, they may experience:
- Taking risks
- Loss of interest
Patients who are addicted to opioid use require a lot of support and careful management to reduce their dose. Without guidance from healthcare professionals, the risk of relapse is high.
Other Reasons for Opioid Tapering
While treating addiction and managing chronic pain are the commonest reasons for opioid tapering, some medical professionals may recommend using it for other reasons:
- Addiction prevention: Patients with a personal or family history of substance abuse may require tapering to prevent an addiction.
- Side-effect management: Some individuals experience opioid-related side effects that make life difficult to manage, like drowsiness and constipation. In these cases, an opioid taper may help them find a daily dose that manages their pain with fewer problems.
- Alternative pain relief: Sometimes, patient preference determines whether someone continues using opioids. Patients can choose to try another form of pain relief but might need medical guidance to do so.
- Prescribing guidelines: Doctors usually need to prescribe drugs according to guidelines. When it looks as though a patient’s required dose is about to exceed recommendations, they may suggest tapering to maintain the right dose.
- Preoperative tapering: Sometimes surgeons recommend perioperative tapering ahead of a procedure. Evidence suggests that patients who use opioids may have poor postoperative outcomes, such as developing infections and difficulty breathing.
In all the scenarios above, patients may benefit from medical guidance while attempting dose reduction. Seeking support can offset some of the effects of opioid withdrawal.
What You Should Know About Opioid Tapering
Opioid tapering isn’t something patients should try alone. In some cases, patients may need to continue with long-term opioid therapy. The CDC recommendations include:
- Risks vs. benefits: The benefits of no longer prescribing opioids must outweigh the risks of stopping them.
- Pregnancy: Pregnant women may be at risk of miscarriage or premature labor because of stopping opioids. Medical teams should address opioid use during pregnancy on a case-by-case basis because of this.
- No return: The CDC states that doctors cannot reverse tapering, but they can slow it down or pause it.
- Gentle approach: It’s best to take a gradual approach to reducing opioids. The CDC recommends starting at 10% per month for someone who has been taking opioids for over a year. Or 10% per week for someone who has been taking them for a few weeks or a few months.
- Safety netting: Doctors must advise their patients that it takes as little as a week to lose tolerance, placing them at higher risk of an opioid overdose. Some physicians may offer naloxone to their patients as an overdose prevention strategy. Patients will also need careful mental health monitoring to identify their risk of suicide, depression, and anxiety.
When a patient chooses to engage with an opioid tapering program, they’ll experience significant benefits when completing it. It’s still important to be aware of short-term risks, including:
- Withdrawal symptoms: Some symptoms can be distressing, including insomnia, muscle aches, nausea, and anxiety. It’s important that patients communicate side effects to their doctors, as they may be able to prescribe medications that help.
- Managing pain: Patients usually begin taking opioids to tackle pain. Physicians need to manage their patients’ pain carefully during the tapering process.
- Psychological distress: Some people become psychologically dependent on opioids and experience distressing emotions when they withdraw from them. Receiving ongoing psychological support may prevent distress.
- Relapse: Beginning an opioid taper doesn’t always mean a patient will complete it. There’s a risk of relapse, especially when someone has a history of addiction. Doctors should try to prevent this as part of their initial opioid tapering plan.
- Medical complications: Sometimes, ongoing disease control makes it hard to reduce opioid use. This is more likely to happen when treating cancer patients, as cancer pain is often difficult to control using non-opioid drugs.
When a doctor believes their patient is an appropriate candidate for opioid tapering, they can look forward to various benefits, including:
- Reduced addiction risk: When someone needs prescription opioids as part of an initial pain management plan, moving onto another class of drug can prevent addiction.
- Less physical dependence: Patients who require long-term opioids may benefit from dose reduction to prevent physical dependence. Another benefit of this is that they’re less likely to experience increased tolerance, allowing opioids to remain effective.
- Preventing overdose: Patients on a lower dose of opioids are less likely to take so much that they overdose.
- Managing side effects: Opioids can cause constipation, drowsiness, and anxiety. These side effects can make life uncomfortable, and drowsiness can affect a person’s ability to work and drive. Eliminating opioids or reducing the dose makes it easier to manage side effects.
- Better pain management: While opioids provide pain relief, they’re not always the most appropriate drug. Tapering allows patients to safely explore more effective methods. For example, people suffering from neuropathic pain might benefit from anticonvulsants.
- Reduced mental health concerns: Opioids may make depression, anxiety, bipolar disorder, and schizophrenia worse. When this is the case, tapering helps patients enjoy a better quality of life.
- Long-term benefits: Long-term complications of opioid use can include gastrointestinal disturbances, slower breathing, insomnia, a weaker immune system, and hormonal changes. Stopping opioids lowers the risk of such complications.
Under the guidance of qualified medical professionals, opioid tapering is a safe way to help people reduce or stop their opioid use. It’s beneficial for those who suffer from substance abuse and those who need to alter their pain management plan for other reasons.
It’s important for anyone considering an opioid taper to receive expert guidance. If you require support for reducing your opioid use, you can find it here at Cured Nation. We provide addiction treatment that’s convenient for you, making it easier for you to stop using opioids.