Effective Buprenorphine Discontinuation Guide by Dr. Donald R. Wesson

1. Discontinuing Buprenorphine Donald R. Wesson, MD

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

3. Have a Well-defined Reasonfor 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)

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

5. 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

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