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How long should I stay on Suboxone? Learn all about Suboxone treatment duration

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April 6, 2021

Should I taper off of Suboxone?

The first question regarding any proposed medical intervention is often, “How long is this treatment going to take?” Does a blood pressure medication need to be taken for a week or for life? Is a cancer treatment going to last for four weeks or two years? 

Likewise, treatment duration is one of the most common questions asked when an individual considers taking Suboxone to treat opioid use disorder. And the frustrating answer is: it depends. Opioid use disorder encompasses a wide severity range, which leads to a wide spectrum of treatment duration - from weeks to years to a lifetime. 

On one end, individuals who have taken opioids after an invasive surgery or injury may have difficulty stopping the medication just a few months later as pain resolves; if there are no other complicating factors, a short taper over a few weeks may be effective. This fairly novel use of Suboxone is encouraging, as such patients may be able to address mild dependence long before it progresses to life-altering consequences. Johns Hopkins bioethicist Travis Rieder documented his difficulty quitting opioids months after a severe motorcycle accident shattered his leg in 2015, even as he had access to medical specialists at his world-renown employer; one can only hope that options for type of care have improved since then. 

On the far other end of the spectrum, I once prescribed Suboxone to a seventy year-old patient who had been dependent on heroin for fifty years; we agreed that between long-term dependence and age-related health conditions, the small benefits of tapering off Suboxone were not warranted against the obvious risks to his health from withdrawals, relapse, or recurrent alienation from his long-suffering family if he returned to heroin. 

Most people fall between these two extremes, so most courses of treatment fall somewhere on the spectrum between a few weeks and a lifetime. In general, longer duration of treatment seems to lead to better outcomes overall.

How long will my Suboxone taper last?

If one decides to taper Suboxone, the next question might be how long a taper should last. It is likely (although not proven) that tapers are most likely to be successful if they are slow enough to avoid most withdrawal symptoms. While any taper is apt to cause some withdrawals, it is possible to decrease Suboxone so slowly (for example, 1/2mg every couple of months) that withdrawal symptoms are unlikely - especially if tapers are halted when relapse-risky circumstances arise, such as a stressful life event or new injury. Very slow tapers may be frustrating to individuals who find themselves feeling well and stable on Suboxone after years of fighting opioid dependence; however, long term sobriety from opioids may hinge on patience even as many people feel hurried to get on with their lives.

The following questions can help decide the appropriate timing and duration of a Suboxone taper:  

What is the motivation for a rapid taper, is it realistic, and how does it fit with a patient’s values?
  • Solid motivations for tapering off Suboxone include a feeling of readiness to taper or a personal desire to be free of the whole opioids issue. However, pressure from friends, family, or a recovery community intolerant to medications for opioid use disorder (MOUD) can push people to taper or discontinue Suboxone too soon with negative consequences like relapse and overdose. Financial limitations are also a common cause of early discontinuation and subsequent relapse to opioids.
How long has a person been taking opioids, at what dose, and at what age did they start?
  • A rapid taper over a few days or weeks might be helpful for someone who has only taken opioids for weeks to months, but rapid tapers are not likely to be successful for individuals with long duration of use. 
Are other conditions present that would make tapering difficult or dangerous?
  • Comorbidity - a term not common outside of medical jargon until COVID19 made it a household word - refers to any condition that accompanies the main medical issue of concern. Comorbidities that commonly accompany substance use disorders include chronic pain, anxiety and mood disorders (such as depression or bipolar disorder), poor sleep, PTSD, attention deficit disorder, and many others. Because these conditions are often tied up in the opioid use itself, it is wise to bring them under control before tapering Suboxone so that the underlying causes of opioid use do not re-emerge with the taper. Some physical conditions such as advanced heart failure may make all but the slowest tapers unwise as the stress of tapering may worsen the underlying condition. 
How much distress tolerance (the ability to withstand stresses of unpleasant or uncomfortable situations) does a person possess, and how much of that do they want to use up on a rapid Suboxone taper?
  • Some who people tolerate or find meaning in physical challenge - such as athletic feats or persevering against physical adversity - may also tolerate a taper that causes overt symptoms. Others may find they have worn out their tolerance for distressing sensations and conditions due to prior trauma or overall life stressors. Still others may find that they can withstand cravings and withdrawals without relapse, but that the energy it takes to tough out cravings would be better spent engaging with family, progressing at work, or pursuing hobbies. 
Have MOUD tapers been unsuccessful previously?
  • An individual who has repeatedly tapered off buprenorphine/naloxone (Suboxone) only to find themselves relapsing would be ill-advised to discontinue Suboxone again without some change to the underlying circumstances, as relapse to opioids after a time of sobriety with or without Suboxone brings a risk of overdose.

With all this in mind, the setting for a successful taper might include critical assessment of the motivation for tapering, values-based balance between risks and benefits of tapering, realistic expectations of the process, and vigilance about danger signs such as overwhelming cravings and withdrawals. Most of all, listening and minding your body’s signals leading up to and throughout the tapering process is crucial to avoid unnecessary relapse. Prioritizing function (as measured by engaging in the aspects of life an individual priorizes, such as family, work, or other activities) over time-based goals can help keep a person on track. 

Working with doctors who care

Unfortunately, definitive studies have not been completed to define the optimal length of time to stay on Suboxone or the best tapering rate, although comprehensive studies of opioid recovery are underway. In the absence of solid data, science must turn to art: finding the right pathway for each person to minimize risk of grave harm (such as severe relapse leading to overdose), maximize individual goals, and match the patient’s values to their course of care. In the end, the duration of opioid use disorder treatment is a highly individual choice that is best formulated around a combination of personal values and informed consent with the added guidance of an experienced medical provider.  

Bicycle Health can help throughout the spectrum of Suboxone use, from rapid tapers off to long-term maintenance and everything in between. To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.

Photo courtesy of National Cancer Institute on Unsplash.

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