Opioid medicines – lowering my dose

Also called opioid tapering

Taking opioids such as morphine, oxycodone or codeine for pain over a long time is not recommended, unless the pain is caused by cancer. If you have been taking opioids regularly or for a long time for non-cancer pain relief, work on a plan with your doctor to lower your opioid dose gradually.

Opioid pain medicines are used to treat moderate to severe short-term pain, such as after an operation or serious injury, or ongoing pain from cancer or for palliative care. They are not recommended for the treatment of chronic (ongoing) pain that is not related to cancer. Read more about opioids and opioids in palliative care.

Why is using opioids for long-term relief of non-cancer pain a problem?

Taking opioids for pain over a long time is not recommended, unless the pain is caused by cancer. Over time the benefits decrease and the risk of harm increases.

  • Your body gets used to opioids, which means they don’t work as well over time.
  • The amount of pain relief from opioids can become less at higher doses because of tolerance to the medicine.
  • Sometimes opioids can actually cause your pain to get worse. This is called 'opioid-induced hyperalgesia'.
  • The chance of side effects, and dependence, increases with time. 

What are the benefits of reducing or stopping opioids?

The benefits of reducing or stopping opioids gradually include:

  • feeling more alert and in a better mood
  • feeling able to do more activities, including socialising or work
  • being able to drive
  • experiencing less pain
  • fewer side effects or risk of overdose.

How can I lower my opioid dose safely?

Develop a plan to lower your opioid dose

If you have been taking opioids for a long time for non-cancer pain relief, it is important that you have a plan with your doctor to lower your opioid dose gradually, rather than just stopping taking them. This is called tapering. Suddenly stopping opioids can cause severe withdrawal symptoms. 

What is tapering?

Gradually lowering your opioid dose or tapering is a planned process that allows you to lower your dose or stop your opioid use completely. This reduces the chances of withdrawal symptoms. The process includes the following steps:

  • Understanding that it takes time to stop an opioid. Your opioid medicine will be reduced slowly. The time it takes depends on how much you take and your own circumstances.
  • Having regular reviews with a doctor to discuss how tapering is going. See your doctor regularly while lowering your dose, to monitor your progress and talk about any issues you may be having.
  • Building a support network. Lowering your opioid dose can be difficult. Prepare your support group, including your family/whānau, friends and healthcare team.
  • Managing withdrawal symptoms if they happen. Some people have withdrawal symptoms. Symptoms may include flu-like symptoms, nausea, diarrhoea and stomach aches. These are temporary and usually not dangerous. Your doctor may recommend reducing your dose more slowly if these symptoms are difficult to manage. 
  • Using other strategies to manage pain. You will need to use other strategies to manage pain before, during and after lowering your opioid dose. Strategies may include being more active, stretching or relaxation techniques.

Read more about lowering your opioid dose.

What are opioid withdrawal symptoms?

Withdrawal symptoms can occur because of physical or psychological dependence, which can take as little as 1 month to develop. So when an opioid dose is lowered, you may experience a ‘withdrawal’, and your mind and body can respond negatively.

Therefore it is important that you reduce your opioid use slowly so that withdrawal symptoms don't occur or are minimised.

Withdrawal symptoms vary for each person. They are usually quite different to what is experienced when taking an opioid, eg, opioids can cause constipation, while withdrawal symptoms can include diarrhoea.

Symptoms may include sweating, nausea, abdominal pain/cramping, diarrhoea, trouble sleeping, muscle aches, fast heartbeat, anxiety, runny nose and goosebumps. Withdrawal symptoms during tapering can last for 4–10 days. While unpleasant, they are not dangerous.

How to manage withdrawal symptoms

Withdrawal symptoms are best managed together with your doctor, who may prescribe medicines to treat the symptoms such as nausea and vomiting. It’s important to have a responsible adult with you if you are having withdrawal symptoms to check that your medicines are taken correctly.

Unless advised otherwise by a doctor, there are also strategies that may help with symptoms of opioid withdrawal. General strategies may include:

  • relaxation techniques
  • listening to music
  • using distraction, such as talking to someone with a positive outlook
  • being more active and stretching
  • drinking plenty of water to replace any fluids lost through sweating and diarrhoea – people on restricted fluids should check with a doctor about fluid intake.

Strategies and medicines for specific symptoms 

These strategies may be helpful, and you can also ask your doctor or pharmacist for advice:

  • Nausea and vomiting: eat small, frequent meals, and bland food, avoid spicy, fatty or strong-smelling foods. Some people find ginger can help. 
  • Gut cramps: hyoscine butybromide, an over-the-counter (OTC) medicine.
  • Diarrhoea: loperamide, an OTC medicine.
  • Headaches, muscle aches and pains: paracetamol and/or nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen oral tablets and gels or creams rubbed into the painful area.
  • Insomnia (inability to sleep): chamomile tea or sleep hygiene.
  • Anxiety/agitation: lavender oil or another complementary medicine.

Learn more

Opioid medicines and chronic non-cancer pain NPS Medicinewise, Australia

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 27 Aug 2020