Tapering off opioids: When and how

If you've taken opioid medications for more than a couple of weeks, it's likely you need to stop soon — and stop slowly, to avoid severe symptoms of withdrawal.

By Mayo Clinic Staff

When it's time to stop using the opioid medication

Opioids are powerful painkillers. Despite the risks associated with opioid use — including high rates of abuse, addiction and accidental overdose — they may still be the best option in certain situations, such as for acute, short-term pain.

Your doctor may prescribe opioids to help you get through a few days of severe pain after surgery or a traumatic injury. Opioid medications also play an important role in treating cancer-related pain and, rarely, chronic, noncancer pain when other treatments haven't worked.

If you've taken opioids for less than two weeks, you should be able to simply stop these medications as soon as your prescribed course of pills runs out, if not before. Ask your doctor if you're not sure when you can stop your medications.

If you've taken opioid medications for more than two weeks, you may need to stop using these medications as soon as possible to prevent serious consequences. Common signs that it's time to get off opioids include serious side effects, reduced pain relief from the same dose of medications over time (tolerance), or behaviors that raise concerns about misuse, abuse or addiction.

Don't try to go cold turkey on your own. Opioid withdrawal can be dangerous, and symptoms can be severe. When it's time for you to stop taking opioids, ask for your doctor's help to develop a medication withdrawal plan (called a taper) that gradually reduces the amount of medication you take. Depending on the type and dose of the drug you've been taking and how long you've been taking the drug, it may take weeks or even months to gradually and safely reduce your dose and get off your opioid medication.

Stopping opioids can be difficult, but you can do it. You're much more likely to succeed if you partner with your doctor and your health care team, plan your taper schedule, manage your symptoms, and learn alternative ways to cope with pain.

Not sure if your medication is considered an opioid?

Some examples of the many opioid medications on the market today include:

  • Hydrocodone (Hysingla ER, Zohydro ER)
  • Hydrocodone-acetaminophen (Anexsia, Norco)
  • Fentanyl (Actiq, Duragesic, Fentora)
  • Oxycodone (OxyContin, Roxicodone, others)
  • Oxycodone-acetaminophen (Percocet, Roxicet, others)

Ask your doctor if you don't know whether your pain medication is an opioid.

What a safe opioid taper involves

The right length for an opioid taper varies with each person and each medication. Your doctor should prescribe an opioid taper schedule that addresses your medical needs while minimizing risks to your health.

During your opioid taper, your doctor may:

  • Regularly monitor your pulse, blood pressure and temperature
  • Request urine or blood samples to check the type and amount of medication or other substances in your system
  • Ask for your permission to speak with your other health care providers, pharmacist or family members to get information that may help with your medication taper
  • Introduce other pain therapies as needed
  • Prescribe other types of medications to help you manage withdrawal signs and symptoms such as sleep, appetite and mood disturbances

Follow your withdrawal plan closely, especially your doctor's instructions about how and when to take medications during the taper. Although you may be eager to reach your goal, your body needs time to adjust to lower levels of opioids, and then to none at all. A step-by-step reduction in your dose helps this process go smoothly and helps ease the discomfort you may feel as you stop taking opioids. It also allows you to practice new skills to manage pain and other chronic symptoms.

You may be tempted to take more medication than your taper requires. Don't supplement your taper with additional medications from home, visits to the emergency room, or with alcohol or street drugs. If you feel the need to supplement, contact your health care team.

Withdrawal symptoms

Some people experience withdrawal when they stop or reduce the use of opioid medication. Symptoms may vary, depending on several factors, such as which medication you're taking and the length of use. Tapering can help reduce or eliminate withdrawal signs and symptoms.

Signs and symptoms of withdrawal include:

  • Runny nose, watery eyes and yawning
  • Restlessness or anxiety
  • Irritability or mood disturbances
  • Increased pain
  • Goose bumps on the skin, chills or sweating
  • Stomach cramps
  • Nausea, vomiting or diarrhea
  • Muscle cramping or aches and joint pain
  • Tremors or muscle twitching
  • Rapid heart rate
  • Blood pressure changes
  • Trouble sleeping
  • Thoughts of suicide

If you experience withdrawal symptoms, tell a member of your health care team right away. Follow all instructions you receive about managing withdrawal symptoms.

Unless you're instructed otherwise, you may also find these tips helpful:

  • Drink more water or other liquids than usual.
  • Eat regular nutritious meals.
  • Use deep-breathing and stretching exercises, as instructed.
  • Exercise in moderation (for example, walking).
  • Do something to relax (for example, practice relaxation techniques, listen to music or read).
  • Use distraction (for example, humor or talking to someone with a positive outlook).
  • Use positive self-talk. Tell yourself "I can do this" or "This is only temporary."

The key role of social support

Talk with your doctor if the taper process becomes difficult. Your health care team can assist and encourage your success.

Your doctor may recommend combining your taper with counseling on medication use. Counseling can help you learn strategies to cope with stress, identify early warning signs of relapse and avoid opioid use. Depending on your pattern of medication use, your doctor may recommend continued chemical dependence counseling after you've completed your opioid taper.

In addition, you may find it helpful to join a substance misuse support group (for example, Narcotics Anonymous) or talk with your religious or spiritual advisor.

Considering opioid use in the future

Someday you may face an acute problem such as injury or surgery. If you've successfully tapered off opioid pain medication in the past, taking opioids for a brief time — with guidance from your doctor — may be appropriate. Discuss all your medication and pain management options, including pros and cons, with your doctor.

Let your doctor know whether you had any trouble tapering off opioids in the past. He or she may recommend alternate pain medication, especially if you have a chronic pain condition.

From Mayo Clinic to your inbox

Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

May 20, 2021 See more In-depth

See also

  1. Medication-free hypertension control
  2. Alcohol: Does it affect blood pressure?
  3. Alpha blockers
  4. Ambien: Is dependence a concern?
  5. Angiotensin-converting enzyme (ACE) inhibitors
  6. Angiotensin II receptor blockers
  7. Antidepressant withdrawal: Is there such a thing?
  8. Antidepressants and alcohol: What's the concern?
  9. Antidepressants and weight gain: What causes it?
  10. Antidepressants: Can they stop working?
  11. Antidepressants for children and teens
  12. Antidepressants: Side effects
  13. Antidepressants: Selecting one that's right for you
  14. Antidepressants: Which cause the fewest sexual side effects?
  15. Anxiety: A cause of high blood pressure?
  16. Atypical antidepressants
  17. Automated external defibrillators: Do you need an AED?
  18. Bedtime routines: Not just for babies
  19. Beta blockers
  20. Beta blockers: Do they cause weight gain?
  21. Beta blockers: How do they affect exercise?
  22. Bipolar disorder and alcoholism: Are they related?
  23. Bipolar disorder
  24. Bipolar in children
  25. Bipolar medications and weight gain
  26. Bipolar treatment: I vs. II
  27. Blood pressure: Can it be higher in one arm?
  28. Blood pressure chart
  29. Blood pressure cuff: Does size matter?
  30. Blood pressure: Does it have a daily pattern?
  31. Blood pressure: Is it affected by cold weather?
  32. Blood pressure medication: Still necessary if I lose weight?
  33. Blood pressure medications: Can they raise my triglycerides?
  34. Blood pressure readings: Why higher at home?
  35. Blood pressure tip: Get more potassium
  36. Blood pressure tip: Get off the couch
  37. Blood pressure tip: Know alcohol limits
  38. Blood pressure tip: Stress out no more
  39. Blood pressure tip: Watch the caffeine
  40. Blood pressure tip: Watch your weight
  41. Screenings of newborns and athletes for genetic heart disease
  42. Caffeine and hypertension
  43. Calcium channel blockers
  44. Calcium supplements: Do they interfere with blood pressure drugs?
  45. Can whole-grain foods lower blood pressure?
  46. Can't sleep? Try daytime exercise
  47. Central-acting agents
  48. Choosing blood pressure medications
  49. Clinical depression: What does that mean?
  50. Coffee after dinner? Make it decaf
  51. Depression and anxiety: Can I have both?
  52. Depression, anxiety and exercise
  53. Depression: Diagnosis is key
  54. Depression in women: Understanding the gender gap
  55. Depression (major depressive disorder)
  56. Depression: Provide support, encouragement
  57. Depression: Supporting a family member or friend
  58. Diuretics
  59. Diuretics: A cause of low potassium?
  60. Do you know your blood pressure?
  61. High blood pressure and exercise
  62. Free blood pressure machines: Are they accurate?
  63. Home blood pressure monitoring
  64. Heart arrhythmia
  65. High blood pressure (hypertension)
  66. High blood pressure and cold remedies: Which are safe?
  67. High blood pressure and sex
  68. High blood pressure: Can you prevent it?
  69. High blood pressure dangers
  70. How opioid addiction occurs
  71. How to tell if a loved one is abusing opioids
  72. Hypertensive crisis: What are the symptoms?
  73. Insomnia
  74. Insomnia: How do I stay asleep?
  75. Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills
  76. Intervention: Help a loved one overcome addiction
  77. Isolated systolic hypertension: A health concern?
  78. Kratom: Unsafe and ineffective
  79. Kratom for opioid withdrawal
  80. Lack of sleep: Can it make you sick?
  81. L-arginine: Does it lower blood pressure?
  82. Low blood pressure (hypotension)
  83. Male depression: Understanding the issues
  84. MAOIs and diet: Is it necessary to restrict tyramine?
  85. Marijuana and depression
  86. Medications and supplements that can raise your blood pressure
  87. Menopause and high blood pressure: What's the connection?
  88. Mental health: Overcoming the stigma of mental illness
  89. Mental health providers: Tips on finding one
  90. Mental illness
  91. Monoamine oxidase inhibitors (MAOIs)
  92. Natural remedies for depression: Are they effective?
  93. Nervous breakdown: What does it mean?
  94. Not tired? Don't go to bed
  95. Pain and depression: Is there a link?
  96. Prescription drug abuse
  97. Prescription sleeping pills: What's right for you?
  98. Pulse pressure: An indicator of heart health?
  99. Reactive attachment disorder
  100. Recreational ED drug use
  101. Resperate: Can it help reduce blood pressure?
  102. Selective serotonin reuptake inhibitors (SSRIs)
  103. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  104. Skip booze for better sleep
  105. Sleep deprivation: A cause of high blood pressure?
  106. Stress and high blood pressure
  107. Teen depression
  108. Teen drug abuse
  109. Nutrition and pain
  110. Pain rehabilitation
  111. Self-care approaches to treating pain
  112. Treatment-resistant depression
  113. Tricyclic antidepressants and tetracyclic antidepressants
  114. Unexplained weight loss
  115. Valerian: A safe and effective herbal sleep aid?
  116. Vasodilators
  117. How to measure blood pressure using a manual monitor
  118. How to measure blood pressure using an automatic monitor
  119. What is blood pressure?
  120. Vitamin B-12 and depression
  121. Can having vitamin D deficiency cause high blood pressure?
  122. What are opioids and why are they dangerous?
  123. What's your high blood pressure risk?
  124. White coat hypertension
  125. Wrist blood pressure monitors: Are they accurate?