Stopping Opioids

How to Stop Opioid Therapy

The patient’s degree of physical dependence dictates how to stop opioid therapy.

  • Patients taking only short acting opioids 4 pills per day (any strength) should be able to stop without a taper
  • Patients on long acting medication may need taper
  • Patients on >50 mg Morphine equivalents per day may require taper, with higher doses more likely to require a taper (Click here for a morphine equivalence calculator).

Higher intensity of withdrawal symptoms is linked to:

  • Higher steady-state levels
  • Longer term exposure
  • Faster rate of medication clearance (i.e. long vs. short half-life agents)

How to taper opioid medications:

  • Taper 10-20% per week.
  • Most people can be tapered fairly rapidly in the first 50% of their opioid dose. The last 25% of the tapering is the difficult part.
  • When tapering off of extended-release/long-acting (ER/LA) opioids, a short-acting (immediate release) opioid may help with breakthrough symptoms.
  • To taper ER/LA opioids, build up non-pharmaceutical pain management techniques.
  • High dose short acting agents should not be changed into long acting for the taper as that may increase dependence potential.

When NOT to taper

  • Evidence of illegal diversion or tampering
  • Patient with suspected addiction not willing to engage in treatment
  • Patients without evidence of taking medication (e.g. multiple, negative urine drug screens despite high dose or long acting medication).
  • Patients on low dose short acting medications
  • Patients with addiction
  • If patients are willing to engage in addiction treatment, a short tapering dose is potentially useful to bridge the patient to a detoxification program, or medication assisted treatment (methadone, buprenorphine).

Adjunctive Treatments

  • Non-opioid pharmacotherapy may be helpful for some patients who experience physical discomfort from opioid withdrawal.
  • Behavioral treatment

See also:

Indications for Stopping Opioid Therapy

How to Discuss Stopping Opioid Therapy with the Patient

U.S. Department of Veterans Affairs Fact Sheet for Tapering Opioids


Katz N. Patient Level Opioid Risk Management: A Supplement to the Manual. Newton, MA: Inflexxion, Inc.; 2007.

Portenoy RK. Opioid therapy for chronic nonmalignant pain: a review of the critical issues. J Pain Symptom Manage. 1996 Apr;11(4):203-217.

Webster LR, Dove B. Avoiding Opioid Abuse While Managing Pain: A Guideline for Practitioners. 1st Edition. North Branch, MN: Sunrise Press; 2007.