What is tapering off?

Learn about tapering off, a gradual reduction of drug use, as a safer approach to stopping substance use disorders compared to quitting cold turkey.

Ophelia team
Tapering off pills
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Arthur Robin Williams, MD

It’s a common misconception that quitting cold turkey is the best way to handle substance use disorders. But immediately stopping the use of a substance like opioids without any replacement therapy or adjustment period can lead to dangerous withdrawal symptoms.  

Tapering off is considered a safer approach, but there’s some uncertainty around what this means and how it works. Here’s what you need to know about this process and why it’s not a one-size-fits-all solution. 

What it means to taper off

Tapering off is the process of gradually reducing the amount of a drug a person uses. The goal of tapering off instead of “medication-free” detoxification is to reduce the risk of withdrawal and cravings. 

When someone develops a physical dependency on a certain drug as a result of long-term or frequent, heavy use, their body adjusts—and their brain chemistry can even change. At that point, they’re only able to function normally while using that drug. If they quit cold turkey, they may experience withdrawal symptoms ranging in severity from uncomfortable to life-threatening. 

To help eliminate or reduce these symptoms, some addiction professionals advocate tapering off as part of early treatment. It’s important to note that tapering off with the help of a team of professionals is very different from attempting it alone. If the patient doesn’t gradually reduce their dosage by the appropriate amount, the process may not be effective, and they could still end up experiencing severe withdrawal symptoms or relapsing. Anyone considering tapering off as an initial step in treatment for their substance use disorder should consult with medical professionals for help. 

Your doctor may conduct tests during the taper process to monitor the amount of the addictive substance in your body, regularly check your blood pressure and pulse, and take other measures to keep you as safe as possible. Be sure to follow your doctor’s instructions closely and do not rush the process. By design, tapering off is a gradual process—you need to give your body time to adjust. 

Tapering off methods

Direct tapering

Direct tapering is the simplest tapering off method: The patient gradually takes less and less of the drug they’re dependent on until they can safely stop using it entirely. Often, treatment specialists reduce the drug dose by about 10-20% on a weekly basis. Direct tapering is best suited for patients who use drugs that don’t build up in their systems or who use high doses of long-acting drugs. 

Substitution tapering

If it’s not possible or safe to practice direct tapering, one alternative is substitution tapering. In this method, medical professionals replace the drug the patient is dependent on with a similar but safer prescribed substance that’s easier to taper off. These substitute medications must have a lower abuse potential so it’s safer to gradually reduce the patient’s daily dose. 

Drug tapering off methods: direct tapering and substitution tapering

Risks of tapering off + quitting cold turkey

There are risks involved with both quitting cold turkey and tapering off. With either approach, the patient may experience symptoms of withdrawal, including:

  • Trouble sleeping
  • Aches and pain
  • Nausea and vomiting
  • Chills or sweating
  • Headaches
  • Increased heart rate
  • Mood swings
  • Anxiety
  • Suicidal thoughts

The symptoms a patient experiences will depend on the drug they use and their usage history, among other factors. Tapering off is intended to reduce the severity of withdrawal symptoms compared to quitting cold turkey, but patients will likely still experience some discomfort. 

Ophelia’s patient-focused approach

Rather than medication-free detoxing, Ophelia’s approach to treating opioid use disorder (OUD) is to use Suboxone® and other forms of buprenorphine-naloxone for longer term symptom management. Suboxone is a key part of our medication-assisted treatment (MAT) for OUD. Within 20 to 60 minutes after the first dose, Suboxone can help reduce withdrawal symptoms and relieve cravings. As long as you keep taking it, the medication also significantly reduces your risk of overdose death.  

After an extended period, medically supervised tapering off can be part of a patient’s treatment journey, too. Book a screening and welcome call to learn more about our accessible, patient-focused OUD treatment. Not only do our clinicians create a treatment plan that addresses your unique needs, but you also attend all follow-up sessions virtually from the comfort of your home.


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