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 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)

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