Many healthcare providers today aim to avoid administering or prescribing opioid pain medications when possible because of the addictive properties of narcotics. But, for some patients, opioid medications remain the most effective, most appropriate treatment for their pain.
When opioids are needed, knowing when and how to taper off the dosage is a crucial component to a safe pain management plan. And it’s easiest and safest to do this with the help of a medical expert.
When is it time to start weaning off prescribed opioids?
Weaning off opioids prescribed for acute pain
Acute pain normally fades with healing, is related to tissue damage and significantly alters your everyday functioning. If the opioid you take is for this type of pain, weaning often happens within one to four weeks of the injury, depending on the type of injury.
Weaning off opioids prescribed for chronic pain
Chronic pain lasts longer than the normal healing process – for three months or longer – and the goal of opioid medication for this type of pain is a little different. For chronic pain, opioids aren’t just used to treat pain, but also to improve quality of life and function, using the lowest dose of medication needed to maximize everyday function.
When you have chronic pain and you’re on a high-dose opioid medication and/or your function isn’t improving with that medication, then it may be time to consider tapering down the dose or completely tapering off the medication.
Other reasons to wean off opioid medications
- You experience severe side effects (such as constipation, fatigue, cognitive impairment) that interfere with daily activities.
- You’re not able to comply with the prescribed treatment plan.
- Other health issues (such as sleep apnea, liver or kidney disease, or having a high risk of falling) increase your risk of being on long-term opioid medication.
- There’s evidence of substance use disorder or abnormal behavior.
How are opioid medications usually tapered off?
There’s no general rule to tapering off opioids. Most patients can tolerate lowering their dose by 10% to 20% each week with few withdrawal side effects.
If you’ve been on high-dose opioids and/or have been taking them for a very long time, a slower taper might be necessary – decreasing the dose over a period of months instead of weekly.
Withdrawal and why it’s important to taper off opioids slowly
Opioid withdrawal isn’t life-threatening, but the effects you may feel can be extremely uncomfortable and unpleasant. The symptoms range from relatively mild, such as watery eyes or a runny nose, to unpleasant digestive symptoms and more serious muscle pain, increased heart rate and blood pressure, and anxiety, irritability or depression.
The symptoms of opioid withdrawal can begin within hours to days of an abrupt stop in opioid medication, and they can last for weeks. The symptoms can be worst within the first 48 to 72 hours and improve over time – usually with resolution in five to 10 days.
What to do if pain gets worse during opioid tapering
If pain gets worse, speak with your prescribing physician. Tapering may need to be done at a slower pace, and non-opioid treatment options may be added. This might include topical ointments, anti-inflammatory medications or physical therapy.
Who can help you taper off opioids safely
It's important to communicate directly with a doctor about when and how best to taper off opioids if needed.
Primary care providers often can help with this. If you’re on a very high dose of opioid pain medication, it’s best to talk with a pain specialist who’s board-certified in pain medicine or palliative/hospice medicine. They can help you determine an appropriate weaning schedule.
If there's a concern about addiction, you may be referred to a specialist in addiction medicine.
When healthcare providers individualize an opioid tapering plan, they try to determine the initial goal for each patient. The goal may be to reduce a dose to the lowest dose of opioid medication that can improve both pain and function. The goal could be to completely end opioid therapy altogether.
If there’s a substance use disorder or unusual behavior, it’s important to taper off more quickly, because the risks of continuing opioid medication outweigh the risks of opioid withdrawal.
Another concern is if someone’s been taking a regulated dose of opioid medication long-term. They likely require a longer, more gradual tapering plan than someone who has taken opioid medication for just a few weeks.
Examples of prescribed opioid medications that need tapering
Prescription opioids can include hydrocodone, oxycodone, hydromorphone (Dilaudid), long-acting morphine or oxycodone and methadone.
Managing pain without opioids
There are some non-opioid methods that can help ease chronic pain.
Daily exercise has been shown to be very beneficial. Physical therapy could be useful, and the addition of non-opioid medications – like muscle relaxers, anti-inflammatories and nerve pain medications – may be indicated as well.
The first step in the journey to your best health begins with a primary care provider who cares
Get started today
