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Tapering phase

© 2009 CAMH


Clients often continue to participate in methadone maintenance treatment (MMT) for years, but, at some point, they may decide to try to stop taking methadone. The client's motivation and readiness for tapering off methadone (PDF) is explored in counselling, and clients make the final decision without pressure from the MMT physician or counsellor. 

If clients decide to taper off methadone, they should be fully informed about the symptoms they may experience. The prescribing physician will slowly reduce the client's dose in a way that minimizes withdrawal symptoms. Because methadone is long acting, withdrawal is slow to begin but often lasts longer than it would for shorter-acting opioids, such as heroin. If the rate of taper is too rapid, clients are more likely to experience organic mood syndrome (Kanof et al., 1993), insomnia, depression and anxiety for months after they stop. If the taper is sufficiently gradual, many clients will not experience these symptoms. Delaying or discontinuing the taper may be considered for a client experiencing withdrawal symptoms or cravings that he or she cannot manage.

While an initial tapering rate of five milligrams per week is often considered standard, tapering is client-driven and often much slower. When the dose reaches 20 milligrams a day, the standard tapering rate should be reduced to one or two milligrams per week. In urgent cases (e.g., if a client must end treatment due to a deportation order), the rate of taper can be increased to as much as five milligrams every three to four days. As the client's dose gets very low, clonidine can be offered to help reduce withdrawal symptoms.

On occasion, a client may request a blind taper, in which he or she is not informed about the dose or rate of taper. Blind tapering is relatively rare but can help accommodate clients who are experiencing "detox fear."

If a client is having difficulty with tapering, the dose can be held steady or slowly increased again to the previous optimal dose, where it remains until the client is ready to try tapering again.

Supportive services are helpful during the tapering phase. They may include support groups, relapse prevention programs and various approaches to stress reduction (e.g., exercise, massage or acupuncture). In addition, aftercare planning is important during this period. Counselling need not stop because the client is no longer taking methadone. Clients may be anxious about the possibility of relapse and often benefit from continued counselling that focuses on building social support networks.

For a more in-depth discussion of tapering in the context of MMT, see Chapter 10 of Methadone Maintenance: A Counsellor's Guide to Treatment (PDF).