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).

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.

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).

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

Stopping Opioids