Discontinuing Buprenorphine

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Discontinuing Buprenorphine

• Donald R. Wesson, MD

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Words to use and not use

• Use Discontinuation or Tapering
• Dont use detoxification because it implies
  that buprenorphine is toxic

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Have a Well-defined Reasonfor Discontinuation

• Voluntary
• No longer needed to prevent relapse to heroin use
  (you wont 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)

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Discontinuation of Psychosocial and buprenorphine
Treatment

• Generally a bad idea to discontinue both at once
• Discontinue buprenorphine treatment then
  psychosocial treatment

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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

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Dosing Strategy

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

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