My name is Michelle Marikos. I’m a certified peer support specialist and person living with pain. I was going to school at Chico State and was in a very bad accident and crushed three vertebrae in my neck, didn’t know that I’d even broken my neck and was misdiagnosed, so ended up being in a contraption, a, a halo-type contraption for about six months. I began high-dose opioids and muscle relaxers and anti-inflammatories. I’m John Hart, a physician in physical medicine and rehabilitation. When a person ends up on a high dose of narcotics, and we’re talking about prescription mainly, it was done with good intentions. But they end up on this high dose and we know they have a high chance of overdose. One thing a pain pill does that we like, and that is it gives relief of pain. But when we continue that pain pill long-term, some changes occur in the brain, the big change that occurs that we just simply didn’t know about years ago. We now have a term that’s called “opioid hyperalgesia,” big, fancy term. What it means is the narcotic I’m taking today is what’s going to produce my pain tomorrow. The process of the taper was hard, but with the education piece of knowing how medications work without the, within the body in the long term…. And that the medication wasn’t working anymore, and that the medication was making my pain worse, and to hear that the medication or pain medication can make your pain worse, it turned on the light bulb of, “Well, then I don’t want to be on pain medication if it’s making my pain worse.” I was so desperate to get out of pain. I wanted to seek the cure. I wanted every intervention I could get my hands on to be out of pain. When we, we talk about tapering a person off narcotics, basically, that means reducing the narcotics slowly Remember, no one started out on 100 milligrams of some big amount of narcotics. They worked their way up over time in years, maybe. The same is in reverse. You go the other direction, but you go down slowly. So the two secret words are “slowness, do it slowly,” and “do it consistently.” They may feel a little funky for about one or two weeks, and that’s all. We want to taper slow. Tapering is always better slow. It will mitigate some of the withdrawal effects. You may feel withdrawal effects at the very end; you may feel withdrawal effects at the very beginning. Everyone is different. Its Individualized. if you do it slowly, the symptoms they’ll get are very transit. They’ll last about a week, maybe two. They’re very minor. People go to work. They may notice it a bit. They may notice a little more fatigue. “I have a little bit more aching,” so general body aching. It disappears in one to two weeks and that’s it. If that’s all the symptoms you have, you’re probably doing the taper correctly. Do it slowly. Give it time for the brain to recover. Don’t try to speed it up. Tapering is a process. It is an everyday process. You will feel at times that it’s very difficult, but part of the tapering and why you’re tapering is to be able to get yourself back. The changes a person may see after taper are a couple. They may say, “Wow. My pain’s even better now.” That’s one. Other option we, we will occasionally see, they’ll come off the narcotics. They’ll look at me and I’ll say, “How’s your back?” They’ll say, “Well, Doc, my back’s kind of the same as when I was on the high narcotics. But, Doc, I can think now. My brain’s come back. My life’s better. I still got the same backache, but I can live with it now.” That’s the difference. Hi, my name is Dr. Andrew Suchocki and I’m the primary care provider for Patricia Rosenberg. So, Patricia, we’ve reduced your opiate pain medication requirement per month by about 95 percent over five years. How is your pain now versus when we first started your taper? It’s gotten a hundred percent better. Doing acupuncture and cupping is one of the best things that I’ve ever had, and I will… It’s, it’s just released a whole bunch of different… I can move my arms, my shoulders, and I’m not in pain anymore. I can walk a block or two and it doesn’t kill me. You want to have a very close relationship with your provider and your provider team, going through a taper plan. Your provider and their team are your partners. They really can help you move through this process in a very nice and calm way. So use your team. Ask them questions and find out information that they have to be able to make this process easier. The most important thing is communication and a decision between you and your physician. That’s number one. Talk about the timing you want. Do you want this done every month? Every two months? Feel free. The patient should put in their thoughts about how they want to do it, too. The doctor may have an idea that they want them off in two weeks. The patient may say, “Whoa, wait a minute. Let me. Can we make that two or six months or a year?” Work with your physician. Come up with a plan. Tapering/Reducing Pain Medicine To access more tools and resources related to pain management, visit the Oregon Pain Guidance website at https://www.oregonpainguidance.org/resources/.