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How to Taper Off Opioids

Published April 18, 2017
| Written By SpineNation Editorial Staff  

You've read the stories of other people who have accidentally gotten hooked on prescription painkillers, but you never thought you'd be one of them.

You started taking these drugs to relieve your back pain. Initially, you felt great, maybe even euphoric, but when you finally make the decision to seek alternative treatment options for that pain, you didn't account for how hard it can actually be to stop.

The desire to quit using the prescription coupled with the desire to not feel the pain puts you in a tough spot. You may also feel regret for getting stuck in this vicious cycle and as you've probably learned, the desire to get rid of them sometimes isn't enough. You need more than willpower to break the grip. Tapering off opioids not only places physical distress on your already painful body but the mental dilemma you may face while attempting to quit opioids is something you cannot understand unless you are in it. Feeling sick is the understatement of the year. 

Opioids are a compound found in various prescription pain medications such as fentanyl, hydrocodone, and oxycontin, in addition to illegal drugs like heroin. When taken, your prescription painkiller ignites dopamine — the neurotransmitter that regulates pleasure and reward, as well as movement, emotion, cognition, motivation. Once you're dependent on them, they govern what you'll do to get that reward of staying pain free.

This is the real reason you can't let them go. Addictions fight back.

The American Society of Addiction Medicine reported, “Addiction is not about drugs, it’s about brains. It is not the substances a person uses that make them an addict; it is not even the quantity or frequency of use. Addiction is about what happens in a person’s brain when they are exposed to rewarding substances or rewarding behaviors, and it is more about reward circuitry in the brain than it is about the external chemicals or behavior that 'turn on' that reward circuitry.”

“To compensate for these surges your brain begins to automatically produce much less natural dopamine and other key neurotransmitters. This is what causes many of your most painful opioid withdrawal symptoms.”

In short, your body physically screams in pain from the lack of drug in your bloodstream.

BackerNation is here to provide you the tools in order to point you in the right direction to break the cycle. Let's get to it. 

Understanding the Phases of Withdrawal

If you consume opioids on a long-term basis, your body essentially becomes numb to the drug meaning you need more of it in order to feel its full effects.

Prolonged consumption of opioids alters your brain's nerve cell function causing the cells to stop working until the drug is back in your system. Abruptly stopping or quitting them cold turkey causes your body to react adversely, eventually leading to feelings of need or desire, both symptoms of withdrawal.

Withdrawal takes place in two phases. 

The first phase includes:

  • Muscle aches
  • Low energy
  • Restlessness
  • Anxiety
  • Agitation
  • Tearing eyes
  • Runny nose
  • Excessive sweating while being cold (cold sweats)
  • Insomnia
  • Excessive yawning

The second phase includes:

  • Diarrhea
  • Abdominal cramps
  • Nausea and vomiting
  • Dilated pupils
  • Rapid heartbeat
  • Goosebumps

Phases one and two normally last about four to ten days, however, you may not feel normal for several months. If you consumed a high dose over an extended amount of time, you may develop protracted withdrawal symptoms also known as acute withdrawal. Long-term symptoms are normally not about the physical pain, but rather emotional or behavioral factors.

“Most clients in treatment for substance use disorders (SUDs) do not immediately feel better after stopping their substance use. In a pattern unique to each client, symptoms related to substance abuse may be felt for weeks, months, and sometimes years,” said Dr. Christy K. Scott, director of research and development of the Illinois Health Survey Laboratory in Champaign, Illinois.

“Clients may be affected by less intense versions of the acute signs and symptoms of withdrawal as well as by other conditions such as impaired ability to check impulses, negative emotional states, sleep disturbances, and cravings.”

Dr. Scott continued, “These symptoms may lead clients to seek relief by returning to substance use, feeding into the pattern of repeated relapse and return to treatment.”

According to the University of Wisconsin, understanding what you may experience is the first step in breaking the cycle of post-acute withdrawal.

Here are eight actions you can take to help yourself deal with post-acute withdrawal:

  • Keep your support system in mind, turn to them when you need to
  • Identify and deal with your triggers
  • Use a structured daily routine
  • Eat a nutritious diet
  • Keep a good sleep pattern
  • Exercise daily
  • Do the things that bring you comfort and keep you away from drugs
  • Return to treatment, if necessary

Acute withdrawal is commonly treated with a variety of support therapies and medical supervision. Gradually tapering off the drug along with the use of over-the-counter medications can help to relieve your withdrawal symptoms.

What it All Means

First and foremost, you want to attempt to wean off the prescription medication slowly with help from your medical team. Your doctor can devise a wean off plan. Typically, doses are lowered and managed over time between appointments — usually, 20-50 percent of the original dose is decreased on a weekly basis. Rapid detoxification studies suggest that a patient needs at least 20 percent of the previous day’s dose to prevent withdrawal symptoms. In general, the longer the patient has been on opioids, the slower the taper should be.

Addiction is difficult to manage and nearly impossible to control. Many people find self-regulating to be extremely hard to do alone, which is why it's important to discuss this with your doctor and support system to avoid a possible relapse.

If you fear a relapse may occur, or you are hesitating to taper off the opioids alone, there are many in-patient detox options as well as long-term rehabilitation clinics, if you are currently addicted. There, you will be managed directly by a registered nurse and physician who will perform professional care making you comfortable during the next week of heightening withdrawal symptoms while you wait it out in their specific location.

While your doctor or treatment counselor may or may not prescribe these, there are a few medications used to aid in opiate withdrawal. Please be advised that the below three notated options can be as addictive as the opioids. Please speak with your doctor prior to taking them as you need a medical prescription.

Those medications include:

  • Methadone - aids to diminish withdrawal symptoms making the overall detoxification process easier
  • Buprenorphine - can decrease the length of detox and withdrawal symptoms
  • Clonidine - can treat symptoms like anxiety, agitation, and muscle aches

If you plan on trying to wean yourself off first, the following over-the-counter medications may provide relief for some of the symptoms of withdrawal:

  • Imodium. The active ingredient in Imodium, loperamide, is an opiate receptor agonist preventing and relieving diarrhea by slowing down your digestion system.
  • Dramamine. An over-the-counter medication used to alleviate motion sickness and nausea, this will help relieve the nauseated feeling you get from withdrawal.
  • Benadryl. Treats a runny nose, sneezing, watery eyes, cold symptoms, in addition to insomnia due to its antihistamines.
  • Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, Motrin, or Advil. To relieve your minor aches and pains, consider the recommended daily dose of one of these pain relievers. The recommended dose for adults on all NSAIDs is 400 mg. Follow-up doses are 200 mg to 400 mg every 4 hours as needed, up to a maximum of 4 doses in a 24-hour period. Never use any medication for longer than its recommended usage or in larger doses than recommended.
  • Take time as needed. Consider moving around your work and social schedule, canceling any plans so you can rest and have a movie marathon in the comfort of your own home on days where you're not feeling especially well. 

Holistic Options

The use of vitamins and supplements in treating the effects of opioid withdrawal is a possible option, however solely taking a supplement may not remove the withdrawal symptoms entirely. Consider adding a vitamin to your daily regime.

  • B-Complex
  • Calcium
  • Magnesium
  • Passion Flower
  • Melatonin

Other methods are out there, but it's important to understand that there is little supporting evidence proving they remove your symptoms.

Those alternatives include:

  • Acupuncture
  • Chinese Herbal Medicine
    • Tai-Kang-Ning, - thought to be effective for moderate to severe heroin withdrawal
    • Ginseng
    • U’finer - a Chinese herbal blend thought to repair the damage opiates may do to the brain

Dr. Graham Rogers of South Central Regional Medical Center in Laurel, Mississippi, explained, “In the case of acupuncture, several studies demonstrated reduced withdrawal symptoms when combined with certain medicines. The report of studies on Chinese herbal medications found that the herbs were actually more effective at managing withdrawal symptoms than clonidine was.”

To Conclude

A comprehensive treatment plan can be created specifically for you by your physician who can help you learn how to manage all phases of withdrawal whether in-patient or out-patient.

It's not an easy road, but with help, recovery is possible. Hey, if Muhammed Ali could endure tough training — which he hated — in order to win the prize and be remembered as a legend, you can endure the ups and downs of overcoming addiction. With the right people in your corner, you really can do anything.

Ali declared, “I hated every minute of training, but I said, ‘Don’t quit. Suffer now and live the rest of your life as a champion.’”

Updated: February 19, 2020

Information provided within this article is for educational purposes and is not a substitute for medical advice. Those seeking specific medical advice should consult his or her doctor or surgeon. If you need to consult with a specialist, you may be able find a health care provider in our Specialist Finder. SpineNation does not endorse treatments, procedures, products or physicians.

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