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  • Writer's pictureDr. Harold Pierre

Guide to Tapering Off Suboxone After Long-Term Maintenance: A Patient-Focused Approach to Successfully Taper Off Buprenorphine

Updated: Apr 24

Hey there, friend. I know you've been on a journey with Suboxone (buprenorphine-naloxone) treatment for opioid use disorder (OUD), and now you're ready to take the next step: tapering off buprenorphine. I get it - the idea of letting go of something that's been a constant in your opioid addiction treatment can be scary. But I want you to know that I'm here to support you every step of the way as you taper off Suboxone safely.

I've been helping patients taper off buprenorphine since 1999. Back then, those tapers were about 3 days long. While the acute physical withdrawal symptoms were well managed, I was foolish to think that patients did well after discharge. What I did not consider or even know about, was the Post Acute Withdrawal Syndrome that could last 2-3 years and was one of the major reasons for relapse.

Since those early years, I've learned from my mistakes and have developed a protocol specifically to make sure patients successfully taper off for good without the risk of relapses. Now, my tapering protocol takes 3 or so years and avoids Suboxone withdrawal. Yes, I am sorry for that bad news. This isn't a quick process. I've tried my best to speed up the process and have failed. Although, I do have a promising rapid Sublocade tapering process that I hope to share one day. However, the Sublocade taper may not be accessible to everyone because of the cost. For now, I want to share my buprenorphine taper whichlaw-abiding is considerably cheaper.

Are You Ready to Taper Off Suboxone?

Patient and doctor on tapering off suboxone copy

It is important to know that you don't have to taper off Suboxone. There is no timeframe required to be on Suboxone or to be off Suboxone. What you hear me say all of the time, the goal of treatment is to be functional and law abiding. Before we even think about starting a Suboxone taper, let's make sure you're in a really solid place and are functional and law-abiding. We want to see that you've been relapse-free from all drug use for several years and that any chronic pain issues are well under control. It doesn't make sense to taper if you are still abusing heroin, fentanyl, methamphetamine, or an other drug. Also, it's super important that your life is stable - your finances, relationships, and work situation should all be in a good place. If there's anything that needs a bit of extra attention, let's work on getting that sorted out first. We want to set you up for success as you begin to wean off Suboxone! Despite going slow, there will be mild withdrawal symptoms from time to time that become major problems as your Suboxone dosage decreases.

Finding Your Sweet Spot for Your Suboxone Taper

Once we've got that strong foundation, let's make sure you're on the right dose of buprenorphine for your Suboxone taper to begin. This is what I call your "sweet spot" - the dose that's been keeping you stable and feeling good for at least three months. For some folks, that might be 24mg, while others might need a bit more or less. The key is to listen to your body and work with your medical professional to find that perfect balance as you taper off Suboxone.

Slow and Steady Wins the Race When You Taper Off Suboxone

Now that we've got that ideal dose locked in, it's time to start the Suboxone taper schedule. Now, I know you might be tempted to rush through the process of tapering Suboxone, but trust me - slow and steady wins the race. We'll take it one month at a time, reducing your buprenorphine dose by just 10-15% each step of the way. And here's the key: we'll wait at least a month to make sure all those opioid withdrawal symptoms have totally vanished before we take the next step in your Suboxone taper. This is absolutely the most important part of the whole process. If you're still feeling a bit off, no worries! We'll just hold steady at that dose for a few months until you're feeling 100% again.

Watch Out for Withdrawal Symptoms as You Taper Off Suboxone

Throughout this whole journey to get off Suboxone, keep an eye out for any withdrawal symptoms that might try to sneak up on you. While some suboxone withdrawal symptoms like body aches, sweating, or a runny nose are easy to spot, some others can be a bit trickier, like feeling really tired, anxious, or restless.

In particular, be on the lookout for symptoms of Post-Acute Withdrawal Syndrome (PAWS), which can linger for weeks or months after you've finished your Suboxone detox. Common PAWS symptoms include:

Physical symptoms:

  • Fatigue

  • Sleep disturbances (insomnia or hypersomnia)

  • Muscle tension, aches, and pains

  • Stomach upset, diarrhea

  • Sweating or chills

  • Lightheadedness

Psychological symptoms:

  • Irritability and mood swings

  • Anxiety or panic attacks

  • Problems with focus and concentration

  • Memory issues

  • Depression

  • Dreams of using drugs

Emotional symptoms:

  • Cravings for opioids

  • Feeling emotionally numb or detached

  • Lack of enjoyment in usual activities

  • Social isolation

If you notice any of these symptoms popping up as you taper off Suboxone, you are tapering down too quickly. Remember, I believe PAWS is the number one reason for relapses. So, it is so important that it be controlled before your taper plan continues.

Managing PAWS Symptoms During Your Suboxone Taper

If PAWS symptoms do emerge during your Suboxone taper, you should not continue to lower doses. Instead, let's use the tools in our toolbox to help you feel better. Depending on your specific symptoms, we may:

  • Hold your buprenorphine dose steady for several months to allow your body more time to adjust

  • Add medications like gabapentin, clonidine, or memantine to ease specific opioid withdrawal symptoms

  • Temporarily increase your Suboxone dose to help eliminate PAWS symptoms

We'll work together to find the right combination of strategies to keep you feeling comfortable and stable throughout the process of tapering off Suboxone. Things like regular exercise, a healthy diet, stress-management techniques, and staying connected with your support system can also make a big difference in managing PAWS symptoms. Also, fixing nutritional deficiencies like vitamin D and magnesium may help decrease the severity of PAWS symptoms like cravings and restlessness. 

The Home Stretch of Your Suboxone Taper

As you get closer to the finish line of your Suboxone taper, the buprenorphine dose decreases might get a bit bigger - more like 20-50% at a time. That's just because it gets harder to cut those pills into teeny-tiny pieces. It may be challenging to cut a 2mg tablet into 4 pieces. However, it may be nearly impossible to cut it down to 8 pieces without crushing it into a powder. But don't stress - we've got some ideas to help you further. We can add in some extra meds like gabapentin, Lyrica, amitriptyline, or memantine to keep you feeling smooth and steady. We can have the buprenorphine compounded at a pharmacy to smaller doses. If your insurance covers it, we can switch to Belbuca (buprenorphine films) which is absolutely perfect to easily taper down further.

The Final Countdown to Quitting Suboxone Successfully

Group of people giving a thumbs up gesture copy

The final goal? Getting you down to that last little bit of buprenorphine - usually around 0.15mg - and then saying goodbye to Suboxone treatment for good. I call this part, jumping off. It's a big moment, and I want you to savor it! If we were able to use Belbuca, then this part is easy. Usually, the only additional medication might be gabapentin and clonidine. Otherwise, we might only get down to 0.50mg if the 2mg tablet was our only choice. My goal is that you jump off Suboxone and experience no withdrawal symptoms at all. And that is usually what people experience. That's the advantage of the slow taper.

Easing Off the Extras After You Taper Off Suboxone

Once you've bid farewell to buprenorphine, we'll slowly taper off any extra meds we added along the way. This usually takes about 3-6 months, and we'll go at a pace that feels right for you.

The Goal: A Smooth Transition to Successfully Taper Off Buprenorphine

Now, I'm not gonna sugarcoat it - this process of tapering off Suboxone usually takes a good 3 years from start to finish. I know that might sound like forever, but believe me, it's worth taking the time to do it right. Rushing through a Suboxone taper can really throw your system for a loop, and that's the last thing we want.

You've Got This as You Taper Off Suboxone!

I know this process of tapering off buprenorphine might seem daunting, but I want you to remember that you're not alone. And most importantly, you've got your own strength and resilience to lean on. You've already come so far in your opioid addiction treatment, and I know you've got what it takes to cross that finish line and successfully taper off Suboxone.

So take a deep breath, take it one day at a time, and remember - I'm always just a phone call away if you need a pep talk or a listening ear. You've got this, and I'm so dang proud of you for taking this step to taper off Suboxone safely. Let's do this thing together and get you off Suboxone for good!

About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 25 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.

Disclaimer: This blog post is for the educational purpose of my current patients who are in a Medication Assisted Treatment under my care. For all others, this blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding your health, a medical condition, or anything you've learned from this article and let them decide if this information is right for you.

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