What Is Heroin Tapering?

What is heroin tapering?

The synthetic opioid heroin is one of the hardest drugs to quit, in part because of its unpleasant (and even dangerous) withdrawal symptoms, which can strike regular users after just hours of abstinence. Opioid withdrawals are so difficult they often push patients to continue using.

To minimize withdrawal symptoms from opioids, some doctors recommend a gradual reduction in the user’s doses, which is a process known as tapering. It’s not generally recommended that heroin itself is tapered. However, it can be replaced by medical-grade opioid agonists, like methadone and buprenorphine, which aren't addictive but help reduce withdrawal symptoms. After the patient has stabilized on these alternatives and has been abstinent from heroin for a period of time, the opioid agonist medications can be gradually tapered.

What are the symptoms of heroin withdrawal?

How does opioid tapering work?

Opioid tapering is the slow reduction of a dose in order to minimize withdrawal symptoms.

Tapering is commonly done among patients who have taken prescription opioids for chronic pain for a long time and have developed physical dependencies. In patients who have chronic pain and have taken opioids for more than a year, the CDC recommends doses of the prescription drug be reduced by 10% per month. For those who have taken opioids for a shorter time (weeks to months), a decrease of 10% per week may work.^[4]

Slow reductions in doses aren’t usually done with patients with substance use disorder, who are less likely to comply with tapering regimens and who shouldn’t take an addictive drug for longer than necessary.

Rather, they are tapered using medication-assisted treatment (MAT). MAT is the use of opioid agonists, like methadone or buprenorphine (Suboxone), which also bind to opioid receptors, but they do so more slowly or less completely so they don’t produce rewarding effects, all the while still preventing withdrawal symptoms. On these substitute medications, the patient’s addictive behaviors around the drug may fluctuate, and the dose can slowly be tapered, reducing their physical dependence over time. Patients are also often stabilized on the MAT first, sometimes for a year or more, before a taper is begun.

In the United States, guidelines call for a 10% reduction in doses of methadone every one to two weeks.^[5]

However, methadone and buprenorphine can’t be tapered too quickly or patients will develop withdrawal symptoms, which they may treat with the continued use of illicit, addictive opioids. One study of heroin-addicted patients taking methadone found that those who started tapering after 52 weeks and had a taper ratio of less than 5% per week (but did so consistently) had the best odds of continued heroin abstinence. ^[5]

The rate of tapering will depend on the person, the drug they abused, the amounts they were taking, the length of time they used, any co-occurring mental health conditions, (including other addictions), and other factors.

Some patients may continue to take methadone or buprenorphine for years if they struggle to taper down or if it’s judged they’re at risk of relapse.

Can heroin itself be tapered?

Heroin itself isn’t usually tapered. The drug is illegal and can only be procured on the black market, where doses and purity are difficult (if not impossible) to determine. Continued use of street heroin poses serious risks, including the risks of overdose and blood-borne infections, which outweigh the risks of a cold turkey withdrawal. Additionally, it’s short-acting, meaning dosing has to be regular to avoid heroin withdrawal symptoms, which complicates a tapering schedule.

Some people may try a self-guided tapering of heroin. But it can be difficult to hold yourself accountable and actually decrease your dose of this powerfully addictive substance, even if you could pinpoint the exact amount you're taking.

Can you quit heroin cold turkey?

The withdrawal symptoms of heroin are unpleasant and even dangerous, and they may push you to continue using. That’s why it’s often recommended that you undergo a medical detox.

During detox, you’ll be given medication to ease the symptoms of withdrawal, such as these:^[6]

• Opioid agonists, such as methadone and buprenorphine
• Clonidine, a medication that reduces sympathetic nervous system activity, helping prevent withdrawal symptoms, like an elevated heart rate, high blood pressure, excessive sweating, and temperature fluctuations
• Antiemetics to lessen nausea and vomiting
• Benzodiazepines to reduce anxiety, agitation, and insomnia

In medical detox, the team will closely monitor your vital signs. You may also be given fluids to prevent or treat dehydration, if necessary.