Tapering recommendations. To taper buprenorphine, reduce by 2 to 4 mg every 3 to 5 days until the patient is taking 2 mg/d. Most patients remain on this dosage at least 1 week and then discontinue. Those who experience side effects when dropping from 2 mg to 0 mg can take 2 mg every other day for 1 week and then discontinue.
After patients are tapered completely off buprenorphine, encourage them to follow up with the treating physician for at least another month. Opiate withdrawal symptoms have been reported to linger 2 to 3 weeks after the last dose of buprenorphine, but these symptoms—usually anxiety or insomnia—tend to be self-limiting.5
Case continued: Time to taper?
Mr. T has been free from heroin use for 4 months and has returned to work. He is rebuilding his life and continues with psychotherapy. He follows up at the buprenorphine clinic monthly for medication management. At each visit, he repeats the COWS test and undergoes a urine drug screen and vital signs check.
Related resources
- Substance Abuse and Mental Health Services Administration. Physician locator for buprenorphine providers.
- American Academy of Addiction Psychiatry. Information about buprenorphine training course. www.aaap.org/buprenorphine/buprenorphine.html
- Buprenorphine manufacturer’s Web site. Answers to frequently-asked questions. www.suboxone.com
Drug brand names
- Buprenorphine • Subutex
- Buprenorphine/naloxone • Suboxone
- Buprenorphine (IM) • Buprenex
- Clonidine • Catapres