Tips on managing the physical and psychological effects of tapering from someone who has weaned off of both opioids and benzodiazepines.
In Harper Lee's novel To Kill a Mockingbird, which tells the story of a racially charged criminal trial in mid-twentieth-century Alabama, Jem destroys the flowers of a judgmental, elderly neighbor named Mrs. Dubose and is then tasked with reading to her until she falls asleep at a slightly later time each day.
Jem doesn't discover until after her death that Mrs. Dubose was terminally ill and determined to leave the Earth "beholden to nothing and nobody"; she had been using Jem's reading sessions to distract her from the pain of morphine withdrawal.
She sends Jem a white camellia from her garden, a scene that stayed with me even though I read the novel when I was too young to appreciate anything of addiction.
Atticus Finch, the lawyer representing the African American defendant in the trial, calls Mrs. Dubose the bravest woman he knew.
"Quitting smoking is easy... I've done it hundreds of times." Mark Twain (Samuel L. Clemens)
Contrary to what Mr. Twain had to say about quitting nicotine, there is nothing easy about tapering off of addictive depressants like opioids (hydrocodone, oxycodone, fentanyl, morphine, and other painkillers).
In fact, getting off of these drugs once you've become physically dependent upon them is one of the most difficult things that a human being can do.
It's also one of the most freeing, resilience-building ones, and it will improve your mental and physical condition more than you can possibly appreciate at present.
I call tapering the "boot camp" of recovery because succeeding in it requires the same skills that you will need to maintain your mental health afterward, especially if you have become addicted to your medication.
It demands rigorous planning and intention-setting, but your taper must be flexible enough to allow listening to your mind and body as it progresses so that you can adjust accordingly.
You will likely require comfort meds, but you will also need the discipline to use them sparingly.
You will become proficient in being uncomfortable, in reframing the physical and mental side effects of decreasing your dose so that they don't become overwhelming.
You will probably benefit from the support of a community of some type, and you will need to learn how to stay active and invested even when you're feeling lousy.
As much as anything, you'll need to be gentle with yourself, to forgive and reward yourself.
Before we start: If you're wondering whether your use of prescription benzos or opioids is problematic, check out my 8 Signs That You're Becoming Addicted to a Controlled Substance Prescription.
If you're wondering where to get the comfort meds referenced below and how to use them, consult my At-Home Opioid Detox Protocol, which also contains tips for intention-setting and managing difficult withdrawal symptoms.
The information contained here isn't meant to substitute for a doctor's advice. It's always best to consult with a medical professional before and during a taper if that is possible.
Sometimes, it might be necessary to switch from a short-acting opioid to a longer-acting medication like buprenorphine (Suboxone) or methadone in order to prevent big spikes and dips in blood levels during your taper; a smooth, gradual reduction using a medication with a longer half-life is often best.
Similarly, if you're going off of benzos, you might need to change to a longer-half-life benzo like clonazepam, chlordiazepoxide (Librium) or diazepam.
All the tips discussed here also apply to tapering off of benzodiazepines, but there is an additional risk involved in that process because benzos cause withdrawal seizures that can lead to permanent brain damage or even kill you.
You can obtain a copy of revolutionary British psychopharmacologist Heather Ashton's benzo withdrawal guide here; it is unquestionably the best resource for understanding how tapering from benzos works and planning your weaning process.
With all that preliminary stuff taken care of, let's dive right into it!
Tip #1 - Go Slow
"Low and slow," meaning implementing gradual decreases before ending your taper at a very low final dosage, is the golden rule of tapering.
If your body doesn't have enough time to adjust after each decrease, your withdrawal symptoms are going to accumulate, and before you know it, you'll be so sick that it's going to be necessary to increase your dose to remain functional.
For this reason, you must stick to incremental decreases of no more than 5% or 10% of your current dose, and you must give your body enough time to fully adjust in between dosage drops - a process that can take from five days to two weeks, depending on whether you're tapering with buprenorphine, methadone, or another agent.
When you approach the final quarter of your taper, you are likely to find that your body needs even smaller decreases and that they need to be spaced out further than at the beginning of your taper.
A successful taper has a long, low-dosage "tail" at the end.
If you do it properly, you might find that your body hardly notices when you make the final drop from a very low dosage to taking nothing at all.
Tip #2 - Go Low
When I was first tapering off of Suboxone in the early 2010s, doctors told patients that they could taper down to two milligrams per day and then jump off with little to no withdrawal symptoms.
We now know that this is utter BS, and the current wisdom is that ending your taper at a final dose of 250 to 500 micrograms (0.25 to 0.5 mgs) or less will result in a much smoother finish as well as a diminished risk of post-acute withdrawal symptoms (PAWS).
This principal holds true for all tapers.
The further down you go before you jump off, the closer your body will have come to returning to physiological baseline and the smoother your transition to taking no substance at all will be.
Depending on whether you're tapering with methadone, buprenorphine, or another agent, you're likely going to have to get creative about reliably estimating smaller dosages.
For example, with Suboxone (sublingual buprenorphine) strips, you can dissolve one two- or eight-milligram strip in a few milliliters of water, calculate the strength of the solution, and then dose by volume using an oral syringe (rather than trying to separate the strip into dozens of tiny, equal pieces, which is impossible).
Similar techniques exist for any medication in any formulation. Drop a comment below or use the Contact form if you need help with this.
Tip #3 - Rest Areas
As discussed above, you shouldn't attempt a second dosage decrease until your body has adjusted fully to the first.
Even beyond following this principle, however, it's good to incorporate a few extra plateaus or rest areas into your taper.
Tapering is a mentally and physically arduous process, and being uncomfortable most or all of the time will grate on anyone.
Insomnia takes its toll, too.
I highly recommend that, at two or three points along your taper, you choose a strategic stretch - such as a busy time at work or a holiday period - and linger longer than usual at whatever dosage your body has become comfortable at.
These breathers will restore your resilience and give your body time to deal with accumulated tension, discomfort, and exhaustion.
Tip #4 - Rescue Doses
Used properly as a tool of last resort, rescue doses can save a taper that would otherwise fail.
Rescue dosing refers to taking an increased dose - perhaps increased by 50% or 75% of the dosage that you're currently at in your taper - for a single day when you become overwhelmed.
Like rest breaks (Tip 3), they give your mind and body a valuable break from stress.
However, using rescue doses in any but the most sparing way is playing with fire.
Especially with such addictive drugs, it can be very difficult to limit rescue doses to just two or three occasions when you are truly struggling.
If you use them too often, your body won't be getting the gradual decrease in drug dosage that it needs to taper off.
The best way to manage this is to have someone else supervise your taper.
It's good practice to have someone else hold onto whatever substance you're using to taper with, anyway - doubly so if you have addictive tendencies.
At the start of your taper, explain to that person what rescue doses are and how often you plan to take them (no more than three to five times in the course of a taper that lasts several weeks to six months, is my advice).
Explain that they're intended for when you're reaching the lower doses at the end of your taper and you're really at your breaking point.
Ask their input when you think that you're ready to use one, and make sure to space them out sufficiently so that you're not setting your taper back or running out before the roughest, final stretch of the weaning process.
Tip #5 - Comfort Meds
As I explain in my At-Home Opioid Detox Protocol, it is typically necessary to use comfort meds to manage the physical and mental symptoms of withdrawal, including:
Hydroxyzine (Atarax) for anxiety and insomnia
Lofexidine and clonidine for Restless Leg Syndrome (RLS) and anxiety
Gabapentin for nerve pain / overactivity and agitation / anxiety
Immodium (loperamide) for diarrhea
NSAIDs such as ibuprofen for aches and pains (avoid acetaminophen if you have Hepatitis C or another reason to suspect that your liver is damaged)
All of these medications, as well as a couple of others, can be useful in benzo withdrawal, as well - though gabapentin must be used carefully because it can affect the seizure threshold.
Insomnia is perhaps the most serious threat to an otherwise successful taper.
It throws more people off than severe physical discomfort, in my experience.
It will warp your thoughts and emotions until you do something impulsive that you'll later regret (such as giving up on your taper or taking a massive dose).
Thus, it is crucial to get at least four or five hours of sleep per night.
In addition to the meds listed above, Seroquel (quetiapine) is an antipsychotic that works well for insomnia for many people who are detoxing.
I wouldn't recommend trazodone or antihistamines other than hydroxyzine, as they can leave you very uncomfortable and make RLS worse if you take them and don't fall asleep.
I would not recommend taking a benzo or z-drug for opioid withdrawal unless you absolutely cannot avoid it and are sure that you will be able to take it in a limited way for a very limited time.
Benzo withdrawal is worse than opioid withdrawal, lasts longer, and can actually kill you, and the risk of cross-addiction is just too high.
Leave time for naps!*
*"Lack of sleep never killed anybody," a sarcastic psych nurse who never knew how close she came to getting punched once reminded me when I was on day four of less than two hours of rest per day during withdrawal.
That's not exactly true - there's a prion disease called Fatal Familial Insomnia that drives you insane and then kills you.
Plus, on a more practical level, lack of sleep can lead to impulsive decisions that defeat your taper, and it can cause traffic accidents and other mishaps, as well.
One final note: While it is foolhardy, in my opinion, to attempt to taper without using the comfort meds available to you (which help to decrease the strain on your mind and body), getting off of these drugs requires building up resistance to physical and mental discomfort.
It's important to get away from the mentality of "I feel X uncomfortable symptom, so I need to take Y medicine immediately."
Use these comfort meds respectfully, according to their dosage instructions; set limits on your use of them and stick to those limits.
Oftentimes, if I'm feeling mild to moderate withdrawal symptoms, I'll set a timer for taking a comfort med.
For example, "If I'm still feeling this anxious in two hours, I'll take a gabapentin"; "If I haven't fallen asleep by one a.m., I'll take Seroquel or hydroxyzine."
Practicing using coping skills other than popping meds, which reinforces the addictive mindset and erodes your personal agency, is an essential part of surviving a taper.
Tip #6 - Physical Exercise
During the roughest parts of your taper, you will likely want to do nothing less than go out and get some exercise.
However, it's imperative that you do just that.
Exercise helps to rid your body of toxic byproducts of extended substance use.
It accelerates healing from the damage caused by months or years of chemical dependence, and it releases feel-good neurotransmitters like endorphins, which you will need to compensate for the loss of the cheap, easy lift provided by mind-altering drugs.
Taking a hot shower after a long run has been the wellbeing high point of many of my methadone taper days.
Tip #7 - Tools from Therapy
If you haven't ever engaged in therapy, tapering is a great time to start.
If you have learned some tools from Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT), now is the time to cling to them like you're Rose and they're the floating door during the final scene of Titantic.
During my benzo taper, I had to keep reframing my anxiety - to remind myself that fear and excitement are almost indistinguishable neurologically, and that what I was interpreting as overload was really just my body and mind waking up after a really long time of being sedated.
I learned to look at these hypomania-like symptoms as similar to the come-up from MDMA or another stimulant drug and to appreciate the energy and creative ambition that came with them.
DBT is the set of tools that you want for your taper.
It includes physiologic hacks for dealing with out-of-control anxiety, such as immersing your face in ice-cold water.
It emphasizes radical acceptance of mind-body state and employs mindfulness techniques that will allow you to inhabit your radically-accepted mind and body without going crazy during this time of tumult.
Although working with a trained therapist is the gold standard option, you can learn many CBT and DBT skills through workbooks and YouTube videos available for free online.
If you're not sure where to start, I wrote an article called Four Key Questions to Ask Yourself Before You Book Your First Therapy Appointment to help you determine what therapeutic approach will suit you best.
Tip #8 - Journaling
I highly recommend buying a journal before you start your taper and setting aside at least 10 minutes a day to write in it about how things are going.
This is an excellent way to take stock of your overall progress.
When you're having a particularly rough day, it's great to be able to look back to see how far you've come.
During the first day or two of your taper, I'd make a list of your reasons for getting off of whatever drug you're tapering off of.
Looking back at this list later on is a great way to remind yourself of why you're doing what you're doing.
During particularly difficult dose decreases, sometimes I'll write a detailed description of how liberating it's going to feel to be completely off of methadone.
I'll list all of the things that I hate about being dependent on an opioid - especially that constant, back-of-the-mind monitoring of long it's been since you've taken the medication and how long it will be until your physical withdrawal becomes noticeable again.
I call recovery happiness without a half-life™, and I use my journal to remind myself of why I'm enduring this discomfort.
For many creative people, tapering is a time of enhanced verve.
One of my heroes, the rock goddess Stevie Nicks of Fleetwood Mac, talks about how the month that she spent in the hospital getting off of the benzo Klonopin (clonazepam) was like "being pushed through the door into hell" (paraphrased).
However, she also spoke about how this was an immensely creative period for her.
Even if you're not an artist in the professional sense, there is great joy and healing in creating beauty through art, music, or writing.
This is a great time to pick up a new hobby. If you're not feeling up to joining a group, then maybe pick up a book of mandalas and color at home for an hour or two.
In general, distraction is three-fifths of the law as far as tapering goes.
You'd be shocked by how much your physical and mental discomfort abate when you get absorbed into an interesting book, show, or project.
Tip #9 - Avoid the Pitfalls
You would not believe how many people become alcoholics during the tapering process.
Alcohol dehydrates you and depletes key nutrients; it destroys quality sleep and increases anxiety.
It burdens your liver and poisons your nervous system.
You will become physically dependent on alcohol more quickly if you start drinking while you're coming off of benzos or opioids.
Please don't touch it during your taper. It's probably the worst thing that you can do for your healing mind and body.
If you absolutely "need" some form of chemical escape, then marijuana is probably the least harmful option.
For many reasons, I wouldn't recommend it, though.
You should also be on the lookout for your brain finding creative tricks to get its dopamine fix in other ways.
Be alert so that you don't fall into impulsive / compulsive patterns when it comes to sex, food, and gambling, as well.
Be on the lookout for signs of excess rigidity in general, even when it comes to healthy things like exercise and cleaning / studying / work.
They can be signs of a "dry drunk" mentality emerging, which all addicts / alcoholics are at risk of following cessation of their drug of choice.
The key to recovery is letting go of the need to control and the locked-in rigidity of addictive behaviors.
We need to learn to be fluid, to live "life on life's terms."
It's an auspicious time to seek some spiritual development, if that's something that you're interested in.
It's also a wonderful time to find fellowship and to reach out to other people who are struggling (AA Etiquette: What To Know Before You Hit Your First 12-Step Meeting contains instructions for finding nearby Alcoholics Anonymous and Narcotics Anonymous meetings [at bottom of article]).
Tip #10 - Reward Yourself
You are doing something that is frightening, difficult, and incredible.
Take time to celebrate your progress and to reward yourself.
I'm the stereotypical opioid addict sugar fiend, so Dutch apple pies and tiramisu are how I tell myself thank you from the future me.
For moms / dads, busy professionals, and anyone else who doesn't want to end up with diabetes, incorporating an extra hour or two of free time / downtime into your schedule can feel nearly as good.
At the end of your taper, consider a substantial purchase, a short trip, or a get-together.
Anyone who has tapered off of one of these drugs deserves it. Period.
Fin
Feel free to use the comments section and the Contact form to ask specific questions about taper timelines, comfort meds, and other topics.
Don't forget to join me on Instagram (concreteconfessional)! It's usually easiest to message back and forth there if a longer conversation is necessary.
Lastly, to anyone who is even thinking about getting off of benzos or opioids: I am so proud of you, and I will support you in any way that I can.
I have heard from several readers who used the resources on this site to aid in their withdrawal from buprenorphine, oxycodone, and other drugs, at least two of whom are over 90 days clean at present.
Checking in with them and hearing about their progress is a greater reward than I could've imagined at the start of this blog project.
Stay well (or at least alive),
B.
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