How to Taper Off HydrocodoneAnna Ciulla
Maybe you started taking Vicodin or another opiate narcotic to relieve pain following surgery, or your doctor prescribed the potent painkiller to help you cope with chronic pain not alleviated by non-narcotic drugs. Vicodin is the brand name of hydrocodone, a powerful opiate narcotic that is both effective at analgesia (pain relief) and highly addictive when used for more than the recommended short-term use. When tolerance, dependence or addiction to hydrocodone takes over your life, you may decide that getting off the drug is a priority. But how do you do that safely? You need to be armed with the facts about how to taper off hydrocodone.
WHAT IS HYDROCODONE?
Hydrocodone is a semi-synthetic drug that belongs to the class of opiate narcotics. As a semi-synthetic opiate, hydrocodone is derived from a natural source of opium, but is synthesized and produced in a lab setting. Hydrocodone is classified as a Schedule II controlled substance by the Drug Enforcement Agency (DEA). As Schedule II, hydrocodone can only be prescribed as one 30-day prescription at a time, since the abuse and addiction potential is high.
HIGHLY ADDICTIVE AND POTENTIALLY DEADLY
Hydrocodone definitely serves a legitimate purpose in helping to alleviate acute pain, yet its use must be carefully monitored and controlled, since the opiate narcotic is highly addictive and can lead to overdose and death.
The Centers for Disease Control’s National Vital Statistics Reports, analyzing the top 10 drugs causing drug overdose deaths during a six-year period, 2011-2016, found the opioid class of drugs consistently ranked in first place. Opiates in the ranking included fentanyl, heroin, hydrocodone, methadone, morphine, and oxycodone.
In 2017, hydrocodone products were the most commonly misused subtype of pain reliever drugs, according to the 2017 National Survey on Drug Use and Health (NSDUH), with an estimated 6.3 million people misusing these opiates. These hydrocodone drugs included Vicodin, Lortab, Norco, Zohydro ER, and generic hydrocodone. The main reason for misusing prescription pain killers was to relieve physical pain (62.6 percent). An estimated 1.7 million adults over the age of 12 had diagnosable pain reliever use disorder in 2017.
WHY TAPER FROM HYDROCODONE?
When getting off hydrocodone for good is the goal, one of the main reasons to taper is that this is a steady and balanced way to do so. Tapering gives your body the opportunity to both self-correct and adjust to living without hydrocodone.
A second reason to taper from hydrocodone is that tapering inhibits withdrawal. Some of the annoying opiate withdrawal symptoms kept at bay include nausea, muscle aches, and psychological symptoms affecting the central nervous system.
WHO ADMINISTERS A TAPER FOR HYDROCODONE?
A family physician or other outpatient addiction treatment professional, or an inpatient or residential treatment professional is best to administer a hydrocodone taper.
Tapering on your own, a process known as going cold turkey, is not recommended. For one thing, you’re not equipped to know what to do if withdrawal symptoms set in, and you’re similarly ill-equipped to know the proper dosage or frequency of tapering. If you miscalculate, take too little or too much, you may experience complications or a sudden onset of opiate withdrawal symptoms.
At best, these may be uncomfortable or painful. At worst, other adverse complications could ensue. You may revert to full-blown hydrocodone use as a way of stopping the opiate withdrawal symptoms, in which case you’ve defeated your purpose for the hydrocodone taper: to get off hydrocodone.
What Happens First?
When a physician or addiction treatment professional meets with an individual who expresses a desire to get off hydrocodone use through tapering, there should be an earnest discussion about the entire tapering process, what happens and when.
Before initiating the taper with any patient or client, it’s important for the doctor or treatment professional to make sure they know the doctor will not abandon them – even if tapering doesn’t work. Clear communication now will help in establishing trust and increasing the likelihood of a successful hydrocodone taper.
Goals should be established before tapering begins. The idea is to reduce pain in patients who have been taking hydrocodone to manage pain, while letting them know that there may be some pain initially. Another goal is to improve mood, while a third goal is to improve day-to-day functioning.
It’s also crucial for your doctor or treatment professional to manage your expectations by framing this as a trial taper with a clear exit strategy to follow if tapering fails to work. You need to know that tapering will not be a straight-line process and that there will be ups and downs along the way. When you’re advised of this at the outset, you’re less likely to be discouraged when you experience some setbacks during the tapering process.
HOW DOES A TAPER FOR HYDROCODONE WORK?
A slow, medically-supervised taper is best to get off hydrocodone use. The hydrocodone taper will be personalized to your situation so that you receive the maximum in evidence-based medication-assisted treatment (MAT). Your doctor will prescribe an opioid taper schedule that addresses your medical needs while minimizing risks to your health.
During the hydrocodone taper, your doctor or treatment professional may do the following:
- Monitor your blood pressure, pulse and temperature on a regular basis
- Require blood or urine samples to check for the presence, type and amount of medication or other substances
- Ask your permission to communicate with your other healthcare providers, your pharmacist, or family members to get information that may be helpful in determining your medication taper
- Add other therapies to help you manage pain
- Prescribe other medications (non-opiate) to help you cope with withdrawal symptoms, including disturbances with sleep, mood and appetite
Guidelines for opioid taper for chronic pain issued by the CDC recommend a decrease of 10 percent of the original dose per week as a “reasonable starting point.” For those who’ve been chronic opioid users, though, the CDC says a slower taper (such as 10 percent per month) may be easier. Close coordination with specialists and treatment experts is also recommended, especially for high harm risk clients, such as pregnant women and those with opioid use disorder (OUD). Psychosocial support and arrangement for OUD treatment, mental health counseling and offering naloxone to prevent opiate overdose are other CDC guidelines for opioid tapering.
Monitoring During Taper
An important part of hydrocodone taper is monitoring, which can be done by the prescriber or the dispenser of the medication – as long as they remain in contact with each other. Monitoring involves scheduling frequent visits to explore how well the client is doing with the tapering regimen, to learn whether the client is experiencing withdrawal symptoms, and to find out if the client is experiencing some of the benefits of tapering, such as decreased pain and improved mood.
Urine drug screening should be used for monitoring. If, for example, the urine tox screen shows the presence of marijuana or other substances, the taper is not working. It may be necessary to edge up to detox, or prescribe substitute medication.
Perhaps most important in the prescriber/treatment professional’s relationship with the client is to involve him or her in tracking their taper. This helps increase the client’s motivation to continue with the taper and also allows earlier identification of setbacks. It’s OK to let your treatment professional know things are not going well, so adjustments in the taper or a switch to another treatment approach may be considered. At no point should the client be prescribed more than 3 days’ worth of medication, if taking on an outpatient basis.
When is a Slow Taper Recommended?
Addiction treatment experts in opioid taper say there are times when a slower taper may be recommended. These include:
- When the client is anxious about tapering off hydrocodone.
- If the client has become psychologically dependent on the hydrocodone.
- When the client has co-morbid cardio-respiratory condition.
- If the client expresses a preference for a slow taper.
HOW LONG DOES A HYDROCODONE TAPER TAKE?
According to the Mayo Clinic, the right length for an opioid taper varies with each person and each medication. In general, however, according to addiction treatment professionals, hydrocodone taper may be completed in 2-3 weeks, or as long as 3-4 months. Even if the taper cannot be completed, however, it might be possible to maintain the client in a lower dose – as long as there are improvements in mood and everyday functioning.
WHAT YOU CAN DO TO ENSURE A SUCCESSFUL HYDROCODONE TAPER
Follow your doctor’s instructions carefully about how to take your medications during the hydrocodone taper. While you probably want to get off hydrocodone as fast as possible, your body needs time to adjust to lowered doses of the medication. Sometimes, your doctor may need to hold your dose steady, or even increase it, if severe withdrawal symptoms appear, you experience more pain, decreased mood or functioning, or have other problems that need to be addressed.
Keep in mind that it is important to keep the same daily schedule (or the schedule prescribed for your hydrocodone taper) for as long as possible. Expect your doctor to make adjustments in the dose, frequency and duration of taper based on your overall progress during the hydrocodone taper process. This step-by-step reduction of the opiate dose in your body helps ease discomfort of withdrawal when you stop taking opiates entirely. The gradual tapering process also allows you to learn and practice through counseling, educational classes and support groups how to manage pain and other chronic symptoms.
Do not self-medicate by augmenting your taper regimen with other medications, street drugs or alcohol. Do not take more or less medications than your hydrocodone taper requires. If you experience problems, discuss what’s happening with your doctor or addiction treatment professional so your concerns can be addressed in a safe and effective manner. Other medications, such as Suboxone or clonidine, or treatments may be prescribed to help you overcome hydrocodone dependence or addiction.
For more about hydrocodone, Vicodin, painkillers, tapering, detox, addiction and recovery, check out these articles:
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Canadian Agency for Drugs and Technologies in Health. “Buprenorphine for Chronic Pain: A Review of the Clinical Effectiveness [Internet].” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28727399
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Centers for Disease Control and Prevention. “Drug Overdose Deaths in the United States, 1999-2017.” Retrieved from https://www.cdc.gov/nchs/products/databriefs/db329.htm
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Mayo Clinic. “Tapering off opioids: When and how.” Retrieved from https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/tapering-off-opioids-when-and-how/art-20386036
Pain Physician. “Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20859312
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