Tapering Off Opiates

With courage and grit, you are ready to begin the process of recovery from opiate dependency or addiction. The path to recovery begins with opiate detox, the critical first phase in taking back control over your life.

When approaching opiate detox it is very important to understand the need for monitoring throughout the process. Stopping opiates, such as OxyContin, Vicodin, Norco, Dilaudid, Opana, and others, requires a scheduled reduction of the drug over a period of days or weeks. Tapering off opiates is necessary in order to avoid serious withdrawal effects that are likely to send you right back to the substance.

The purpose of a structured and monitored detox process is to guide you safely through withdrawal symptoms. By tapering off opiates gradually, withdrawals can be better managed. The detox team will be able to provide interventions to alleviate discomfort, in addition to psychological support. This dual detox strategy leads to substantially higher detox completion rates.

How Do You Become Addicted to Opiates?

The brain has opioid receptors built into its reward center. When an opiate is ingested it triggers the release of endorphins, known as the brain’s “feel-good” chemicals. This causes a sense of euphoria, pain relief, and deep relaxation, a deeply pleasurable effect. The brain sends a signal to its reward center that this feels good and should be repeated.

As repeated use of the drug continues, the brain will begin reducing the natural production of endorphins, which is a sign that tolerance is increasing. This often motivates someone to take higher doses than what is prescribed or to dose at more frequent intervals. Because the drug mimics natural brain chemicals, such as dopamine, the brain will stop producing its own dopamine, becoming dependent on the drug. When the individual attempts to stop using the opiate, he or she will experience highly unpleasant withdrawal symptoms within hours.

What are the Signs of Opiate Addiction?

As with all psychoactive substances, the signs and symptoms associated with an opiate addiction may start off subtly. Gradually, however, as tolerance and dosage increase the signs of addiction will become more evident. Being able to recognize the signs of opiate addiction is the first step in getting help for yourself or a loved one. The next step is to actively seek the necessary lifesaving treatment.

Signs of opiate addiction include:

Addiction behaviors.  There are specific hallmark signs of addiction, including:

• Obsessed with obtaining the drug
• Doctor shopping
• Stealing prescription medications from friends or relatives
• Forging prescriptions
• Stealing money from family members to buy drugs
• Neglecting physical appearance
• Illegal activities
• Inability to stop the drug regardless of negative consequences

Physical symptoms.  There are several physical symptoms of opiate addiction, including:

• Drowsiness and lack of energy
• Chronic constipation
• Constricted pinpoint pupils
• Sleep disorders, such as insomnia
• Decreased appetite resulting in significant weight loss

Behavioral symptoms.  Various changes in behaviors associated with opiate abuse include:

• Seeks repeated refills
• Skips activities or events he or she once enjoyed
• The decline in academic or work performance
• Sneaky behavior, such as the increased need for privacy and isolating behaviors
• Hanging out with a different crowd

Psychological effects. Psychological changes include:

• Increased irritability
• Mood swings
• Nervousness
• Anxiety
• Confusion
• Lack of motivation
• Euphoria
• Psychosis

Health effects.  Opiate addiction can cause physical health risks, including:

• High blood pressure
• Chest pain
• Rapid heart rate
• Shortness of breath

What Can I Expect When Tapering off Opiates?

Detox begins with a thorough assessment by the clinical team. During this process, the clinician will review the factors that may influence the severity of the opiate detox. The detox and withdrawal experience varies in severity from one person to another, from mild to severe. This disparity is due to certain factors that can influence how intense the withdrawal symptoms become. These factors include:

• The length of history abusing opiates
• The daily dosage of opiates
• The individual’s general health status
• Whether there is a poly-drug addiction
• Whether there is a co-occurring mental health disorder

Once the evaluation is completed the doctor will have an idea of what level of withdrawal symptoms will likely emerge, and will plan a tapering schedule. Tapering off opiates allows the person to incrementally adjust to the reduced dosing, versus experiencing intense withdrawals by stopping cold turkey.

The detox process will occur in two basic stages. Factors that influence the timeline include the type of opiate (heroin, prescription medications) and the method of delivery (intravenous, pill form, smoking, inhaling). The total length of the opiate detox will depend on these factors, as well as the opiate addiction history.

The stages of opiate detox include:

Early stage: Withdrawal symptoms emerge within 12 hours and may include:

• Eyes tearing up
• Nose running
• Muscle aches
• Joint pain
• Insomnia
• Sweating
• Fever
• Excessive yawning
• Elevated blood pressure
• Racing heart
• Anxiety
• Agitation

Late stage: Withdrawal symptoms peak on days 2-3 and may include:

• Nausea and vomiting
• Diarrhea
• Chills, goosebumps
• Stomach cramping
• Depression
• Drug cravings

The post-acute withdrawal symptoms (PAWS) are present in some individuals with a long history of opiate addiction. These are usually psychological in nature and can linger for a few months after detox is completed. The PAWS symptoms might include depression, anxiety, and cravings.

After Detox, What are the Next Steps?

Opiate addiction treatment involves a multi-modal approach to help the recovering individual overcome opiate dependency or addiction. Because there is a wide range of contributing factors or risk factors that may result in opiate addiction, the rehabilitation program must provide a variety of therapeutic activities. This helps assure that each person in the recovery program will find a treatment element that resonates with him or her personally. The more actively engaged someone is in the therapies and other recovery activities, the more effective the program is.

Opiate addiction treatment elements include:

• Individual talk therapy. Psychotherapy assists people in making fundamental changes in their responses to triggering events, thoughts, or situations.
• Group therapy. Group sessions help peers in recovery connect and share their personal experiences and discuss recovery-related topics.
•  Family therapy or couples therapy. Including the people closest to you in the therapeutic process helps to reinforce recovery efforts after rehab.
• Medication. Medications may be prescribed for the management of a co-occurring mental health issue.
• Relapse prevention planning. Learning techniques for avoiding relapse, such as new coping skills, emotion regulation, and identifying specific triggers helps prepare for challenges in recovery.
• Holistic activities. Complementary activities such as meditation and yoga, massage, and recreational activities enhance the overall results.
• Nutritional counseling. Learning about the role of nutrition in addiction recovery and how to make healthy changes in the diet.

Does Assisted Treatment (MAT) Prevent Relapse?

Some individuals will benefit from medication-assisted treatment (MAT) during early opiate addiction recovery. Drugs, such as naltrexone, Suboxone, or methadone can be prescribed as step-down opioids that can help stabilize the individual as they become accustomed to living without the opiate. These drugs bind to the brain’s natural opioid receptors and block the effects of opiates. The drugs are regulated by a physician and may be tapered off at some point.

There is some controversy about using MAT due to the addictive nature of these medications and the real risk that these drugs may become abused as well.  Critics claim that MAT simply replaces one addictive drug with another. Supporters of MAT respond by stating that the medications allow the individual in recovery to function at a higher level, thereby improving their quality of life.

What Else Can I Do to Prevent Relapse?

Completion of detox and rehab is only the beginning of the recovery process. Continuing care is a critical phase on the recovery continuum as you move forward in establishing a new sober lifestyle.

Aftercare activities for reinforcing recovery include:

• Sober living. Sober living is practical for those who do not have a supportive home environment. During early recovery in particular, it is important to live in a substance-free space. In addition to being alcohol and drug-free, sober living offers many other benefits, such as establishing a healthy daily routine, being accountable to others, and making new friends in sobriety.
• Participating in a 12-step or an alternative recovery community. These recovery groups provide essential social support and are widely available. In addition to the social support, recovery communities also offer ideal opportunities to give back, such as becoming a sponsor at some point, volunteering at meetings, or assisting at recovery events.
• Outpatient counseling. Engaging in ongoing therapy provides additional psychological support in early recovery. When experiencing setbacks that might threaten sobriety, a psychotherapist can help the person work through the challenge and hopefully avoid relapse.
• Relaxation techniques. Incorporating stress-reducing activities, such as yoga classes or meditation, into the regular routine protects against relapse.
• Regular exercise. Getting regular exercise provides both mental health and restorative physical health benefits.

Tapering off opiates is the first important step of your recovery journey. Rely on the support and guidance of an expert detox team to launch your recovery safely.

Capo by the Sea Luxury Opiate Addiction Treatment Orange County

Capo by the Sea is a luxury inpatient treatment program located in the coastal communities of Southern California. Capo by the Sea specializes in treating opiate dependence and will design a program for tapering off opiates in detox. Capo by the Sea features a beautiful treatment setting, premium accommodations, and highly trained addiction professionals who are dedicated to helping clients achieve sustained recovery. For more information about the program, please contact Capo by the Sea today at (888) 529-2114.