Tapering as a Progressive Strategy: The Need for Policy Changes to Fund a Promising Addiction Treatment

With the recent rise of drug use such as heroin, benzodiapenes, and xylazine, substance misuse has increasingly affected millions of individuals across the globe. The opioid crisis in particular is a major concern that public health experts and policymakers alike combat in increasingly high numbers. In the United States alone, opioid overdose deaths have increased by over 400% since 2000, with over 69,000 deaths in 2020 alone [1]. This has led to a significant economic impact, with many citing as much as $1.5 trillion in the annual economic tool. Exacerbated by factors such as social isolation caused by the COVID-19 pandemic, the crisis has devastated many families and communities.

There are currently several approaches to treating drug addiction. These typically involves a combination of behavioral therapy and medication-assisted treatment. Medications such as methadone, buprenorphine, and naloxone are commonly used to help individuals manage their withdrawal symptoms and reduce cravings. Behavioral therapies such as cognitive behavioral therapy (CBT) involve challenging patients to identify negative thinking and develop more constructive coping strategies, allowing the patients to respond in a more effective way. While these medications and psychological therapies can be effective in managing addiction, they do not necessarily lead to complete abstinence.

Thus, a new potential solution to the opioid crisis is to provide those suffering from drug abuse with a gradually lower dose of the drug until they are able to go on without any drug. This approach, known as tapering, involves gradually decreasing the dose of medication over a period until the individual is no longer dependent on the drug. This can be particularly important for those who have been dependent on drugs for a long period of time, as sudden cessation of drug use can lead to severe withdrawal symptoms and cravings. Another benefit offered by this strategy is that it allows individuals to take control of their addiction. Rather than relying on medications to manage their cravings and withdrawal symptoms, individuals who undergo tapering are actively involved in the process of reducing their dependence on drugs. This can be a powerful motivator, as it can give individuals a sense of agency and control over their addiction.

Tapering has been shown to be an effective method for managing addiction in several studies. For example, a cohort study conducted by researchers in British Columbia, Canada determined that discontinuation of opioid medications led to an increased risk of relapse [2], whereas tapering methods had a significantly lower risk of relapse. This method does not necessarily have to apply to illicit drugs. Another study conducted in the University College London also revealed that while discontinuation of antipsychotic medications led to a significant relapse rate, prolonged tapering periods are associated with lower relapse rates with less severe withdrawal symptoms.

Even though there are many touted benefits of tapering, it is currently not within standard practice and has many detractors. Opponents to the strategy may claim that there are still cost-prohibitive barriers to obtaining the appropriate medical and behavioral support for individuals who are struggling with addiction. This can make it difficult for them to stick to a tapering schedule and may increase their risk of relapse. Another cited challenge is that it is resource intensive. In addition to medical supervision and monitoring, the approach requires an adequate supply of drugs for a tapering schedule. This can increase the overall cost and burden on healthcare systems.

Regarding access to public health resources that are needed to help treat those with substance abuse disorders, there are many ways of increasing access to these resources. For example, community-based support groups, such as 12-step programs like Narcotics Anonymous [3], are often free or have minimal associated costs. Furthermore, with rapid developments of telehealth services during the COVID-19 pandemic, individuals who have concerns about substance addictions can readily schedule consultations with professionals to articulate their needs. This facilitates timely acquiring information on strategies, such as tapering, aimed at reducing their dependency on the drug. To address potential financial barriers to tapering programs, one effective approach involves restructuring existing block grants like the Substance Abuse Prevention and Treatment Block Grant (SABG). This would help to allocate a greater emphasis within these grants specifically to support and implement the tapering strategies in treatment programs.

Tapering remains a promising approach to managing addiction. It offers individuals a way to gradually reduce their dependence on drugs and take control of their addiction. With the right support and resources, tapering can be an effective tool for combating the opioid crisis and helping individuals to live healthier and happier lives. In order to make tapering a more accessible and effective tool for managing addiction, policymakers and healthcare providers must work together to provide better access to medical and behavioral support. This may include expanding access to addiction treatment programs, increasing funding for research into new treatment methods, and developing new guidelines for tapering schedules and dosages.

1. Drug Overdose Death Rates. 2023.
2. Kennedy MC, Crabtree A, Nolan S, Mok WY, Cui Z, Chong M, Slaunwhite A, Ti L. Discontinuation and tapering of prescribed opioids and risk of overdose among people on long-term opioid therapy for pain with and without opioid use disorder in British Columbia, Canada: A retrospective cohort study. PLoS Med. 2022 Dec 1;19(12):e1004123. doi: 10.1371/journal.pmed.1004123. Erratum in: PLoS Med. 2023 Mar 21;20(3):e1004213. PMID: 36454732; PMCID: PMC9714711.
3. Hoffman KS. Narcotics Anonymous. 2023.