Chronic opioid therapy is not a long-term solution for pain. And it shouldn’t be the first choice in the treatment for those with chronic pain.
The recommendations in this blog post focus on pain lasting longer than 3 months or past the time of normal tissue healing, outside of active cancer treatment, palliative care, and end-of-life care.
Like many medication therapies in modern medicine, opioid therapy certainly has its pros and cons that must be weighed beforehand. While opioids are effective for pain short-term, they do not provide long-term relief of pain or improvements in physical function. If you have been taking these medications long-term it is probably best you begin to wean off them (with the help of a professional). How do you know when it’s time to taper off of a narcotic opioid?
Here are 7 clear signs it is time to taper:
- You are suffering from the many adverse side-effects.
- You are are taking an opioid along with a benzodiazepine (this combination increases the chance of death).
- You have to continue increasing the opioid dosage in order to find relief.
- You want to live a life without being dependent on a prescription medication.
- **You have reached a plateau in opioid therapy with no clinically meaningful improvement in pain and function.
- **You show early warning signs of overdose risk such as confusion, sedation, or slurred speech.
- **You shows signs of substance use disorder (e.g. work or family problems related to opioid use, difficulty controlling use)
Opioids are known to have significant adverse health effects. This is one of the main reasons why it’s important to have a plan to taper. Common side effects of persistent opioid use include:
- Physical dependence
- Focus and concentration
- Respiratory depression
- Poor coordination
- Hormone disruption
With over 250 million opioid prescriptions made each year, it is no wonder that 2+ million people are dependent on opioids in the U.S. alone (1). Tapering and integrating natural methods along with healthy coping mechanisms are the solution for Americans and the rest of the world.Chronic opioid therapy is not a long-term solution for pain Click To Tweet
How to Taper Off Opioids
If you are dependent on opioids for your pain, it may be hard for you to imagine living a pain-free life without them. But there is good news most prescribers have not shared with you.
TRUTH– most people have IMPROVED FUNCTION and DECREASED PAIN after they taper off an opioid!(2)
Fortunately, there is a simple process to taper off of opioids. If you follow the process I am about to describe, you will have no problems with kicking opioids out of your life and taking control of your pain.
(Always talk to your prescribing physician before tapering off opioids or any other prescription medication).Most people have IMPROVED FUNCTION and DECREASED PAIN after they taper off an opioid! Click To Tweet
Devise a Tapering Strategy
Whether you have been taking opioids for a couple of months or a couple of years, it can be hard to abruptly stop. Suddenly stopping opioids can lead to unpleasant symptoms of withdrawal and can possibly cause harm.
One proven method for opioid weaning is called tapering. This process involves decreasing the opioid dosage by a certain amount over a specific period of time.
It is best to gradually decrease the opioid dosage when trying to taper
Slow and steady wins the race when it comes to having a successful opioid taper.
- To start off, people typically undergo a decrease of 10% of their original dosage per week.
- People who have been taking opioids for a longer period of time may need to cut this back to a 10% decrease per month (2).
The tapering process can last for a couple weeks or months depending on your individual needs. Addicts and abusers of opioids may require a faster tapering process to prevent any harm from an overdose.
Here is an example of a conservative tapering strategy to provide you with an idea of what it would be like for someone taking MS Contin (extended release morphine tablets):
|Weeks||Single Dose||Frequency||Total Daily Dosage|
|Week 1-2||230 mg||Twice daily||460 mg|
|Week 3-4||215 mg||Twice daily||430 mg|
|Week 5-6||200 mg||Twice daily||400 mg|
|Week 7-8||190 mg||Twice daily||380 mg|
|Week 9-12||175 mg||Twice daily||350 mg|
|Week 13-16||160 mg||Twice daily||320 mg|
|Week 17-20||145 mg||Twice daily||290 mg|
|Week 21-24||130 mg||Twice daily||260 mg|
|Week 25-28||115 mg||Twice daily||230 mg|
|Week 29-36||100 mg||Twice daily||200 mg|
|Week 37-44||90 mg||Twice daily||180 mg|
|Week 45-52||80 mg||Twice daily||160 mg|
|Week 53-60||70 mg||Twice daily||140 mg|
|Week 61-72||60 mg||Twice daily||120 mg|
*this template can be adjusted based on the patient’s progress, clinician rationale, etc
Keep Moving Forward
There may be times during the taper that seem more difficult than others; this is normal.
- Refrain from increasing your dosage at any point during the taper.
- Don’t reverse the taper; however, the rate may be slowed or paused while monitoring and managing withdrawal symptoms.
Your goal should be to taper slowly and comfortably. You can prevent the unwanted symptoms of withdrawal by following a slow taper. This is not a race. Some of the signs of opioid withdrawal include:
- Muscle aches
- Increased tearing
- Nausea and vomiting
Keep Track of the Results
Throughout the tapering process, stay mindful of the level of pain that you are feeling throughout the day. A great way to keep track of your pain levels throughout the taper is journaling. In your journal keep track of the intensity of your pain each day. One useful tool for measuring your pain is the numerical rating scale (NRS). The NRS is a valid pain scale that is easy to use and gives accurate measurements of pain intensity (3). To use this scale, you will choose a number on a scale of 0-10 with 0 representing no pain and 10 representing the worst pain you could imagine. Along with measuring your pain in your journal, you can also give small descriptions about your pain. This could include the location of your pain and an adjective describing how your pain feels (achy, burning, throbbing, etc.). By keeping track of your pain throughout your weaning process, you will be able to determine how you are responding to the wean, and whether or not you are ready to move on to the next step.
Do These 3 Things to Live Opioid-Free and Pain-Free Forever
Tip #1: Build a Support Team
You are not in this alone. There are numerous people who are going through a similar situation as you, and it can be helpful to build relationships with these people. Building a support group will help you cope better and increase your chances of sticking to the taper (4). Your support group may consist of family and friends or you can ask your doctor about support groups run by mental health professionals. Some excellent benefits of being a part of a support group include:
- Decreasing feelings of isolation and judgment
- Having someone to hold you accountable
- Improving coping ability
- Having someone to discuss your thoughts and feelings with
- Reducing distress, depression, anxiety or fatigue
- Giving you an idea of what to expect based on others’ experiences
- Receiving support and advice about the tapering process
Having someone by your side throughout the tapering process will definitely make the process easier to negotiate, and it could even lead to new lifelong friends.
Tip #2: Ask For Professional Help
You should be under the direction and supervision of a professional while undergoing an opioid taper, and sometimes you may need to reach out to clinicians other than your prescriber.
The tapering process can be psychologically challenging, and it can be beneficial for you to connect with a psychologist or mental health professional that specializes in opioid tapering, addiction, or pain management.
Many primary care physicians report being uncomfortable providing counseling due to time constraints or inadequate training (5). For this reason, you should ask your primary care physician if they offer any form of counseling or if they can refer you to someone who specializes in counseling patients who are tapering off opioids.
You can search the American Psychological Association’s website for a licensed clinical psychologist.
Tip #3: Explore Different Coping Mechanisms
One of the most important features of a successful taper from includes integrating coping mechanisms that are free of side effects and work to reverse your pain.
There needs to be something in place of the opioid to support you mentally, physically and spiritually. There are online programs accessible from the comfort of your home that are affordable and provide lifestyle support.
Integrative therapies can decrease pain intensity, improve function, and promote better coping with chronic pain than opioids without any negative risks (6). There are a plethora of integrative therapy options available to help you cope with your pain including:
- Physical therapy
- Mindfulness-based stress reduction therapy
- Cognitive behavioral therapy
- Acceptance and Commitment Therapy
- Gentle yoga
Collaborate with your practitioner and determine which of these therapies may be beneficial for you. Often a combination of therapies is needed to treat pain.
Remember, reversing pain requires an integrated approach.
If you need help to better understand what to eat, how to move, or how your thoughts and emotions affect your pain, I hope you’ll consider attending my Free Webinar on Healing Pain Naturally.
You’ll learn how to use the power of your mind to heal; as well how nutrition and gentle movement can reverse your pain. Does this sound like something you need?
This webinar will provide you with the info to change your life, almost immediately.Sign-up for the free webinar here (I’ll email you a recording, too!)