Tapering and Discontinuation of Patients from Buprenorphine

After stabilizing on buprenorphine, patients may request to be tapered off of buprenorphine. Discontinuing buprenorphine in stable patients should be discussed thoroughly with the patients and their significant others. Unfortunately, relapse rates are high and patients should be encouraged to return for maintenance treatment if cravings develop after withdrawal.

Discontinuation of buprenorphine typically involves a gradual reduction of the patient's maintenance dose. For most patients, this tapering should take place over a period of 2 weeks, where dosage is decreased by 2 mg every 2 to 3 days. During this reduction phase, withdrawal symptoms should be monitored carefully and treated in the same way as they were during induction. If and when these symptoms arise, tapering should be temporarily suspended until the patient is stabilized at his/her current dose.

Rapid Tapering

Reduction can also take place over a period of as short as 3 days, for those patients who have immediate and compelling needs to discontinue use, such as a pending health issue (surgery) or job requirements. However, rapid tapers may increase the likelihood of withdrawal symptoms and subsequent relapse, and you should consult with an experienced buprenorphine provider in such circumstances.