How to Stop Opioid Therapy

Degree of Physical Dependence Dictates How to Stop Opioid Therapy
  • Patients taking only short acting opioids 4 pills per day (any strength) should be able to stop without a taper.
  • Patients on long acting medication may need taper.
  • Patients on >50 mg Morphine equivalents per day may require taper, with higher doses more likely to require a taper.
Higher Intensity of Withdrawal Symptoms
Linked to:
  • Higher steady-state levels
  • Longer term exposure
  • Faster rate of medication clearance (i.e. short > long half-life agents)
When NOT to Taper
  • Evidence of illegal diversion or tampering
  • Patient with suspected addiction not willing to engage in treatment
  • Patients without evidence of taking medication (e.g. multiple, negative urine drug screens despite high dose or long acting medication).
  • Patients on low dose short acting medications
Adjunctive Treatments
  • Non-opioid pharmacotherapy may be helpful for some patients who experience physical discomfort from opioid withdrawal.
  • Behavioral treatment
See Also: