The Options: A Daily Microtaper or Cut-and-hold Schedule

There are two basic taper schedule types that laypeople choose from: “Daily Microtapering” or “Cut-and-hold”. Each is reported to have different pros and cons.

Suppose, as a hypothetical example, that a person is currently taking 20mg of her drug daily, and she wants to reduce that by 5% this month. This means that her goal is to cut 1mg of her dose over the next month. What are her taper schedule options?
 

Option 1: Daily Microtaper schedule

She could do a daily micro-titration, or Daily Microtaper, in which she’d make teeny-tiny cumulative cuts each and every day from her dose. So if there are 30 days in the coming month, she would cut 1/30th of a mg from her dose the first day, cut 2/30ths of a mg the second day, cut 3/30ths of a mg the third day, and so on. On the 30th day, she’d be cutting a total of 1mg overall from her dose compared to the first day of the month, which would bring her to her taper goal for the month.

Option 2: Cut-and-hold schedule

She could do a less-frequent Cut-and-hold schedule, in which she’d make slightly-larger, less-frequent cuts and “hold” the dose steady in between. So in this example, the most simple version of a Cut-and-hold means that at the beginning of the month she would make a cut of 1mg in her dose, and then would hold steady at that dose until the next month. Alternatively, instead of making daily micro-cuts, she could cut her dose once weekly: She would cut 1/4th of a mg from her dose on the first day of the month and “hold” that cut through the week, then cut 1/2 of a mg from her dose on the eighth day of the month and “hold” that cut through the week, cut 3/4ths of a mg from her dose on the fifteenth day, and cut 1mg from her dose on the 22nd day of the month. In a variation, she might cut her dose by 1/2mg on the first day of the month, and cut 1mg on the fifteenth day, holding through to the end of the month. Either way, she would have reached her reduction goal by the end of the month.

Here’s a simple analogy to compare Daily Microtapering and Cut-and-hold approaches. Imagine that you’re at the top of a tall hill and you want to get down to sea-level below. You see two routes available before you: The first is a staircase made of many small steps that wind down and around the hill a number of times, so that you would descend very, very gradually to the bottom. Because the route is so easy, you could walk at a continuous, steady pace. The second route is a staircase made of far fewer steps that go down one side of the hill. These steps are steeper and further apart so that you would have to leap off each step to get to the next one, take a breather for a while, and then leap to the next one. So which route would you prefer to take?

Both Daily Microtapering and Cut-and-hold schedules have been used successfully by people in the withdrawal community. Some people try one type of schedule to start with, and switch to the other if they are having problems.

Photo courtesy of Hans Splinter and Flickr Creative Commons/This image has been modified.