How Do You Taper Off Suboxone?

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A Suboxone taper involves taking a smaller amount of medication until you find a maintenance dose that's right for you. Your doctor might use this approach at the end of your detoxification program so you have the right amount of Suboxone available when you leave the program.

Tapering off Suboxone involves using smaller amounts of medication until you're taking a lower dose or none at all. 

If you're ready to stop taking your prescription medication, ask your doctor how to taper off Suboxone most safely and effectively. 

Why Consider Tapering Off Suboxone?

There are many reasons that a person may want to come off of their Suboxone. The first reason would be because they feel their cravings to use opioids are well controlled without needing the medication any longer. This is probably most true for patients that have been stable off of opioids for many years. 

Another common reason would be side effects to the medication itself. While Suboxone is generally well tolerated particularly once the body gets used to it, some patients will have persistent bothersome side effects, including nausea, GI upset, dizziness, sexual dysfunction, headaches, etc.

Pregnancy, an upcoming surgery, or significant changes in life circumstances are other reasons why people sometimes decide to discontinue Suboxone. 

What Are The Risks of Tapering Off Suboxone?

The body does usually get used to Suboxone and patients can have withdrawal symptoms when they discontinue using it. Symptoms of withdrawal from opioids like Suboxone are not life threatening, but can be extremely uncomfortable and can cause people to relapse toward repeat drug use in order to ease the uncomfortable symptoms. [5] A risk of relapse is therefore the greatest risk of abrupt discontinuation of Suboxone. If you are trying to come off of your Suboxone, you should do so slowly, not abruptly, and with the assistance of your doctor.

How Do You Decide If You Should Taper off Suboxone?

Using Suboxone for longer periods is associated with a better chance of recovery.[2] The medication eases chemical imbalances in your brain, allowing you to focus on your therapy. Each dose helps you avoid discomfort and cravings so you're less likely to relapse.

Before you think of quitting, consider whether or not you're truly ready to do so. Talk to your treatment team and support network to assess whether it’s the best decision for your long-term recovery.

There is no shame in taking Suboxone for long periods, or even lifelong when necessary. Addiction is a chronic, relapsing condition. If your medication helps you stay sober, keep taking it.

But if you are truly ready to either quit Medication for Addiction Treatment or minimize your prescription medication use, tapering is wise as opposed to going “cold turkey”. When you are ready to taper, talk to your doctor about a plan to do so.

How to Taper Off Suboxone

You probably started taking Suboxone in a tapering format. You took one dose, watched for symptoms, and took another if you felt sick.[1] As you taper off Suboxone, you follow the same process in reverse.

A taper process sounds easy enough. You take a smaller dose each day until you're taking none at all. But a little planning can help you feel much more comfortable and in control.

Follow these steps:

1. Determine Your Dose 

How much Suboxone are you taking right now? How many milligrams are in each dose, and how often do you take the drug? Your prescription should include all the details you need, but if not, ask your doctor or pharmacist. 

2. Set Your Schedule

Are you facing a firm deadline, or do you have time to let your body adjust more slowly? In general, the longer the taper, the more comfortable you will feel. 

3. Prepare Your Medications

A too-quick taper can leave you feeling very sick. Keep solutions on hand to use when you need them. Ask your doctor about other medications that may help abate any withdrawal symptoms, including:

  • Imodium: helps prevent diarrhea associated with withdrawal 
  • Pepto Bismol: helps with GI upset from withdrawal
  • Mild painkillers: Use aspirin or an NSAID to help with headaches and muscle cramps that can be associated with withdrawal

4. Share Your Plans

Tell your friends, family members, and support groups that you are tapering off Suboxone. Ask them to help you and encourage you through process. If the process gets tough, turn to them for support.

5. Work With Your Doctor 

Can you set up and pull off your own Suboxone taper? Maybe. But it's best to let a doctor guide you through the process. Your doctor can help you understand and anticipate side effects and prepare adequately for this transition.

Your doctor can be especially helpful in discussions about why you want to taper off Suboxone. If you want to quit because of difficult side effects, for example, your doctor could suggest a different formulation or dose. You could still get the help you need without abandoning a medication that is helping to keep you from relapsing.

How Long Does Tapering Usually Take?

It depends on the individual. Some people prefer to go quickly, however most people prefer to take things slow in order to minimize any withdrawal symptoms. Most doctors recommend a taper of approximately 90 days[4] or a reduction of approximately 10-25% of your dose per month.

Talk to your doctor before you get started. Together, you can find a plan that works.

References

  1. OUD Induction Handout. British Columbia Ministry of Health. https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/oud-induction-handout.pdf. Accessed June 2022. 
  1. Extended Suboxone Treatment Substantially Improves Outcomes for Opioid-Addicted Young Adults. National Institutes of Health. https://www.nih.gov/news-events/news-releases/extended-suboxone-treatment-substantially-improves-outcomes-opioid-addicted-young-adults. November 2008. Accessed June 2022. 
  1. FDA Approves the First Non-Opioid Treatment for Management of Opioid Withdrawal Symptoms in Adults. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-non-opioid-treatment-management-opioid-withdrawal-symptoms-adults. May 2018. Accessed June 2022. 
  1. Effective Buprenorphine Use and Tapering Strategies: Endorsements and Insights by People in Recovery from Opioid Use Disorder on a Reddit Forum. BioRxIV. https://www.biorxiv.org/content/10.1101/871608v2.abstract. December 2019. Accessed June 2022. 
  1. A Randomized Controlled Trial of Buprenorphine Taper Duration Among Opioid-Dependent Adolescents and Young Adults. Addiction. https://onlinelibrary.wiley.com/doi/abs/10.1111/add.13363. February 2016. Accessed June 2022. 

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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