How to Taper off Heroin

Some heroin users and doctors alike may choose to taper off heroin, which allows a person to quit heroin gradually rather than all at once.

Heroin is a common illicit opioid and contributes to tens of thousands of overdose deaths every year in the U.S. When treating heroin addiction, medical professionals advocate for comprehensive care, including medical detox followed by rehab. Still, some heroin users may choose a different approach: self-detox by quitting “cold turkey.” 

However, there is another option. Some heroin users and doctors may choose to taper off heroin, which provides an intermediate approach — allowing a person to quit heroin gradually rather than all at once.

What Is Heroin Tapering or Weaning Off Heroin?

Tapering is all about easing yourself off a drug. When you taper a drug, you take less and less of it, allowing your body to adjust slowly. By keeping withdrawal symptoms at bay, it is more likely that an individual will continue the recovery process. 

However, tapering heroin can be tricky because heroin doses are not exact from batch to batch. For this reason, it can be difficult to taper off consistently since using less heroin doesn’t necessarily mean it is less potent each time.

How to Taper off Heroin

Tapering off opioids such as heroin requires a strategy. These strategies should be multifactorial:

• Seek medical assistance: Enlisting your doctor for help can help you obtain resources, including a possible referral to a rehab facility, to ease the tapering process.
• Identify a quit date on the calendar: It becomes easier to focus on making a change once a commitment is actually made. From here, the process takes one day at a time.
• Surround yourself with supportive people: A person’s environment is vital in deciding how to taper off heroin. Removing oneself from settings or friend groups with negative influences is best. With adequate support, commitment and medical intervention, even a challenge as serious as heroin use can be overcome.
• Maintain adequate hydration and nutrition: The withdrawal process can be taxing. Maintaining your body’s energy stores can help you through the process.

Types of Heroin Tapering Methods

Several different types of tapering methods exist. However, when it comes to illicit substances like heroin, only one tapering method — substitute tapering — is supported by data. Other types of tapering include direct and titration tapering, which can be problematic.

Direct Tapering

In a direct taper, you slowly decrease the drug dose until you stop it completely. While direct tapering can work well for prescription medications with consistent ingredients, it doesn’t work well with illicit drugs whose potency differs widely by batch. It is hard to do a direct taper of a drug like heroin due to this variability in potency.

Substitute Tapering

In substitute tapering, heroin is exchanged for a different, safer opioid that can be more easily tapered, like buprenorphine or methadone. Medication-assisted treatment (MAT) is a type of substitute tapering recommended by opioid addiction experts.

Titration Tapering

Titration tapering is not recommended. In titration tapering, you dissolve heroin in water and try having smaller amounts daily to taper yourself off. However, a couple of major safety issues are involved with titration tapering. Not only can heroin potency vary between batches, but heroin does not completely dissolve in water.

Why Consider Tapering vs. Stop Heroin Cold Turkey?

The cold turkey detox method is not the physician-recommended course of action for heroin users of any kind, especially for long-time and frequent users with high tolerances, because tolerance vanishes once withdrawal symptoms clear up. When this happens, users are at their most susceptible to overdoses. A dosage they may have been accustomed to before is suddenly far too strong. It would take a much smaller dose to result in a potentially fatal heroin overdose.

Common Heroin Withdrawal Symptoms

Quitting heroin cold turkey can lead to withdrawal symptoms like: 

• Nausea: Perhaps the most overt withdrawal symptoms, diarrhea and vomiting spells can occur for hours at a time.
• Excessive energy or agitation: Heroin withdrawal is characterized by restlessness and feeling incomplete without using the drug.
• Aching: Withdrawal is truly a full-body experience in the worst way. Muscles will throb incessantly, while pain may be felt all over.
• Hot flashes and chills: The body will attempt to self-regulate, leading to bouts of intense heat or shivers. However, the user may not experience any temperature changes on the surface. Sometimes this is a psychological side effect only.
• Depression: Getting through heroin withdrawal is challenging. Such trauma will take a lot out of a person physically and mentally.

Side Effects of Heroin Tapering

When heroin is properly tapered with a substitute taper or MAT, there should be minimal side effects. If you have side effects from such a taper, your taper may be moving too quickly and need to be slowed or stopped for a while. If you are undergoing a taper and have side effects, you should mention them to your doctor or addiction specialist.

Heroin Withdrawal Timeline

Heroin is a short-acting opioid that follows a somewhat predictable withdrawal timeline:

• Withdrawal symptoms start: within 12 hours of the last heroin use.
• Withdrawal symptoms peak: within 24–48 hours of the last heroin use. 
• Withdrawal symptoms resolve: within three to five days of the last heroin use.

Sometimes, a person may undergo protracted withdrawal, in which certain withdrawal symptoms like anxiety, trouble sleeping and depression last for a few weeks to months after the last heroin use. These symptoms disappear over time with continued sobriety.

Heroin Tapering Schedule

A heroin tapering schedule is highly individualized and depends on factors like:

• How much heroin you take
• How often you take heroin
• If you have previously attempted to taper off heroin
• How long you have been addicted to heroin
• Your overall physical and mental health
• If you are addicted to any other substances besides heroin

Because direct and substitute tapers are not recommended and can vary widely along with the drug’s potency, no information on the duration of these tapers is available. However, even substitute tapers can vary widely in duration, with some MAT regimens lasting only the time of the withdrawal symptoms and other times being continued indefinitely to keep the person heroin-free. Your doctor is in the best position to advise you about how long your heroin taper is likely to last.

Medications Used When Tapering off Heroin

The medications used for MAT during a substitute taper for heroin include buprenorphine and methadone. Although the opioid antagonist naltrexone is not used during a taper as it can precipitate withdrawal symptoms, it can be prescribed after a taper is complete to help you stay off heroin in the future. Your doctor can help you decide on the best MAT regimen for you. Your doctor may advise you to keep taking MAT medications long-term if medically appropriate to help you stay away from heroin.

Buprenorphine 

Buprenorphine is a first-choice MAT medication prescribed to prevent heroin withdrawal symptoms during a taper. The drug comes in oral (Suboxone) and injectable (Sublocade) forms. Although either dosage form can be used, some doctors prefer the injectable form as it is given monthly in a doctor’s office, while you must remember to take the oral form every day.

Methadone

Methadone is another first-choice MAT drug to prevent heroin withdrawal symptoms. Methadone only comes in an oral dosage form and, if you’re taking it for MAT, must be dispensed at specialty methadone clinics. Partly because of the logistical difficulty of keeping a person on methadone, some doctors and addiction recovery centers prefer buprenorphine.

Naltrexone

Naltrexone is an opioid blocker that comes as an oral tablet and an injectable drug. Naltrexone is not prescribed during heroin tapering as it can cause withdrawal symptoms instead of preventing them. However, once you have fully tapered off heroin, your doctor may prescribe naltrexone as an alternative to methadone or buprenorphine to help avoid relapse after your taper.

Can Tapering Your Heroin Intake Reduce Withdrawal Symptoms?

Slowly tapering your heroin intake — especially by switching to a MAT substitute taper regimen with buprenorphine or methadone — can reduce your risk of withdrawal symptoms. The entire point of such a taper is to support you by easing you off heroin and setting you up for success as you continue your recovery. Because withdrawal symptoms may increase your risk of relapse, avoiding them through a taper is important.

How The Recovery Village Uses Heroin Tapering

The Recovery Village supports heroin tapering through MAT regimens like buprenorphine as medically appropriate. In our medical detox facility, we can convert your heroin to buprenorphine and slowly wean you off your heroin addiction as your system is cleansed of the drug. This sets you up for a full recovery from heroin as you continue your sobriety. Don’t wait: contact us today to see how we can help.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more