The first step to get off opiates is establishing a goal. Whether the goal is to reduce the amount of opiate you’re taking or quit entirely there are helpful techniques for reducing the associated suffering, in some cases dramatically so.
Before you begin a taper you should decide what is reasonable. This sounds obvious, but most attempts to get off opiates fail because the goal was unreasonable. If you’ve been opiate dependent for a few months, a taper can begin quickly and occur over a few days or weeks. But if you’ve been opiate dependent for several years and your life’s a mess, I recommend suboxone maintenance until you stabilize emotionally and physically. This may take a few weeks or it may require several months. For reference, the average length of suboxone maintenance is in the range of 6 – 12 months but this varies dependent on commitment and available resources. In our practice, a taper can begin as soon as the behaviors associated with active addiction stabilize.
Most attempts to detox off opiates fail due to the simple fact that the planned goal was unreasonable. Set a goal for your taper, whether the plan involves reducing the amount of opiate consumed or stopping altogether. The length of time it takes to taper has a lot to do with how long you’ve been opiate dependent and which opiate you are taking. A general rule of thumb is a 5% reduction every week for short acting opiates such as vicodin and every 2 weeks for long acting opiates such as methadone or subutex/suboxone. A nice slow taper determined by the client, with the advice of an addiction professional, allows the body to adjust to a lower opiate dependency. This makes the physical symptoms associated with quitting opiates tolerable.
After you identify your target goal, get a calendar and write the dosage you’ll be taking for each day going forward. Be reasonable and consistent with the taper. Consider purchasing a pill splitter (don’t cut time-release medications) and a weekly pill planner for managing your pills because it helps you stick to the dosing schedule. (Note: Don’t try this with non-pharmaceutical street drugs. If you’re not working with a doctor you should be!)
Take your daily dose according to the schedule, not when you feel like it, which we call “emotional dosing”. If you are tapering on suboxone, it is best to dose only once daily. Expect to face some fear and discomfort – these are normal feelings but don’t use them as an excuse to get off schedule. Don’t take your dose straight from your pill bottle – separate them into the weekly pill planner. It’s also a good idea to keep your meds away from your nightstand – make sure you are fully awake when you dose. Stay on schedule unless you and your physician decide it can be done quicker. Don’t take less or more than your planned dose. It’s tempting to try to get ahead of schedule but the goal is consistency and discipline, not speed.
A successful taper from opiates requires mental and physical discipline. A tapering schedule with routine dosing accomplishes two things – it helps you relearn the skill of discipline and ensures the level of opiates in your system fall slowly enough to avoid undue suffering. This will greatly improve your success rate by removing precipitous drops in opiate levels that exaggerate withdrawal symptoms. Build discipline by sticking to the plan you set for yourself in the first place. Do not underestimate the power of this. Our addiction is ruled by impulse, and forcing it into a logical box you’ve created forces it to succumb to your logical mind – the same mind that created the tapering schedule.