If you are taking an opioid for chronic pain, you may be wondering
1) Can I stop taking it?
2) Do I still need this medication?
3) Is there anything to avoid withdrawal symptoms?
4) What if my pain comes back?
These are valid questions and concerns that many people taking opioids for chronic pain
have.
Over the past 12 years, I have helped many patients who were taking opioids for years,
to reduce the dose, to stop entirely or to switch to a different but safer opioid.
Watch to the end, as I have some tips for you to have a successful taper.
So, let’s talk about opioid tapering today.
Opioids are the most potent painkillers.
Our body produces our endogenous opioids, these are the endorphins, enkephalins and
dynorphins.
Morphine and codeine are found in nature, in the poppy plant, while other opioids are
made in a laboratory, oxycodone, fentanyl, hydromorphone, tramadol, etc.
When we take opioids, they activate receptors in our body, the mu, delta and kappa receptors.
The more opioids we take, the body starts multiplying the amount of these receptors
in our body.
If these receptors become empty, they crave the opioid, and the person will have very
characteristic symptoms of withdrawals.
These can be very intense and uncomfortable.
Here is a list of opioid withdrawal symptoms: Stuffed nose
Diarrhea Abdominal Cramps
Headache Sweats
Agitation Insomnia
Muscle aches
So, for a person who takes opioids everyday, stopping or reducing the dose may trigger
withdrawal symptoms.
They feel pain all over their body, and it is very confusing with their original pain
that they started taking the opioids for.
It is hard to know: Is it my original pain or is it the pain from withdrawal?
It is very hard to distinguish these two.
So, how would someone go to reduce the opioid dose safely without having to endure withdrawals?
I’ll explain to you how I do it with my own patients:
Before I continue, let me remind you that this video is not intended to replace medical
advice.
If you have a condition that needs medical advice, please talk to your doctor.
This video is for educational purposes only.
If there is an emergency, please go to the nearest emergency department or call an ambulance.
1) If you feel comfortable, talk to your doctor about your plan to lower the dose.
Ask about the possibility of coming back to the original dose if the tapering plan doesn’t
work.
Ask for support related to how to manage the withdrawal symptoms if they are too strong.
2) Talk to your pharmacist.
They are very knowledgeable about strategies to minimize withdrawal symptoms.
For example: If you have stomach cramps, they can orient
you to buy some over-the-counter antispasmodic If you have nausea and vomiting, they can
help you with ginger, or other OTC antinausea medications
If you have headaches, they can show you some OTC painkillers
If you have insomnia, they can guide you about melatonin, magnesium supplements or sleep
positions
3) Ask your doctor or your pharmacist to calculate your total daily dose in terms of “morphine
equivalents”.
So, if you take only morphine, just add all the milligrams that you take in one day.
But if you take weaker opioids, like codeine or tramadol, you need to calculate that in
morphine equivalents.
For example, 200 mg of codeine or tramadol is equivalent to 30 mg of morphine
If you take stronger opioids, like oxycodone or hydromorphone, the number of milligrams
will be less than morphine.
For example, 80 mg of oxycodone is equivalent to 120 mg of morphine
And 12 mg of hydromorphone is equivalent to 60 mg of morphine
If you take various types of opioids, you need to add them all up.
So, once you know the total amount of opioids you take per day, in morphine equivalents,
we can start a tapering plan.
4) I recommend the first cut to be approximately 10% of the total daily dose.
So, if you were taking 90 mg total in morphine equivalent, you may reduce to approximately
80 mg per day.
And I recommend to stay in this dose for about 2 to 4 weeks.
Maybe in the first day your body will have some withdrawals, but soon it will adjust
to the new dose of 80 mg total per day.
Then, you can take another 10%, reducing to approximately 70 to 72 mg of morphine equivalent
per day.
And you keep doing this reduction every 2 to 4 weeks until you reach the desired destiny.
Here are some tips for you to have a successful taper:
1.Focus on your function, not your pain.
Go for a walk, do some activity you enjoy, and practice something that you are good at,
like playing an instrument, cooking, gardening, or painting.
2.If you need to pause the tapering for a few weeks.
There are some external circumstance or something out of your control in your life.
Take a pause, and come back to the tapering plan later.
3.Learn more about opioids, read posts, watch videos, listen to podcasts, talk to other
people who were able to taper their opioids successfully.
4.Avoid contact and conversations with people who are not supportive to your desires to
taper your opioid.
5.Do not feel that you are a failure if you are not able to reduce the dose.
Some people need more time, or they need to do this at another period of their lives.
You may want to reconsider tapering at a later date.
6.Do not try to change other medications at the same time.
Keep the other medications the same, and only work on reducing the opioid dose.
7.Avoid using alcohol to manage withdrawal symptoms.
8.Use your other tools in your toolbox to manage your pain, like exercises, breathing,
meditation 9.Drink more water and eat nutritious meals
10.10Schedule some fun every day I prepared a handout with this summary here.
You can download this handout on this link.
You can also find this link on the description of this video below.
Here are some things that you may feel during the opioid taper:
You are less bloated and less constipated You are more alert, and your thinking is clearer
You are less fatigued Your pain is the same or it is better than
when you were on opioids.
There are some situations where it is dangerous to taper opioids, and you should talk to your
doctor if this is your case: If you have a coronary artery disease
If you are pregnant If you have a severe mental disorder
If you have an opioid use disorder, also known as addiction to the opioid
I hope you find this helpful.
You may watch my other video here to learn about exercises, nutrition and relaxation.
Good bye