Discontinuing Buprenorphine Donald R. Wesson, MD

Words to use and not use Use “Discontinuation” or “Tapering” Don’t use “detoxification” because it implies that buprenorphine is toxic

Have a Well-defined Reason for Discontinuation Voluntary No longer needed to prevent relapse to heroin use (you won’t know until you try) Involuntary Buprenorphine not effective (e.g., heroin use continuing at level similar to pre-buprenorphine dosing) Intolerable office behavior (e.g., drug dealing to other patients)

Discontinuation of Psychosocial and buprenorphine Treatment Generally a bad idea to discontinue both at once Discontinue buprenorphine treatment then psychosocial treatment

Rate of Taper Taper buprenorphine slowly over weeks to months Be prepared to discontinue taper and increase buprenorphine dose if relapse to heroin appears imminent or if heroin use occurs

Dosing Strategy If patient starts having inter-dose opiate withdrawal symptoms, divide dosage to twice or three times daily