Tapering off of buprenorphine

Yes, it is possible and we have helped many be successful with this. If you are in a time of your life working a good recovery program and have learned new behaviors maybe it is time. But no one gets an award for going off of buprenorphine and relapsing/dying. So please be super honest with yourself during this process. It’s ok to reverse course and try again later.

First off, I hear this too many times “I don’t want to be addicted to buprenorphine”. This needs to be re-characterized. Addiction is doing something over and over despite negative consequences. Taken one idea further, jewelry was never stolen or sex traded for buprenorphine. But these were done for many other medications/drugs (use your imagination and fill in the blanks). We don’t say diabetics are addicted to their insulin. We don’t say cardiac patients are addicted to their beta blockers. But stopped suddenly there will be physiologic issues that may be severe and/or uncomfortable. This is the case with buprenorphine. It cannot be simply stopped without “withdrawal” symptoms. This is because the body is expecting this outside source and reacts poorly when it doesn’t get it. So we have a strategy that cannot really be achieved with commercial products.

Before fully committing to getting off buprenorphine, let me help maybe flip the script. You first came to buprenorphine to get off of whatever it is that hijacked your life. And it works super well to help you feel normal and reconnect to your life. It also helps with pain. 8mg of buprenorphine is equipotent to 160mg of morphine for pain control. Some realize as they taper down the pain comes back. If you still have chronic pain, what is your plan of what you will use once off of buprenorphine? If the word has “codone” in it then you should re-evaluate your plan. This is a med that helps with pain, you don’t nod off, you can drive and remember what you said and did and can still poop (but may need some stool softeners). It also helps with depression. So this is a 3-in-1 medication. Quiets the monkey-brain, helps with pain, and helps with depression. So… is this still something you want to go off of?

If the answer is yes, then most who have been successful have been on buprenorphine for at least one year. This is where positive living strategies are often learned. Many have been on it for many years and waited till they felt more confident. It is recommended to start tapering when you are at an 8mg daily dose and are comfortable at this dose. Don’t go from 24mg to 8mg too quickly or the whole stack of cards may crumble. The best success then is taking 12 months from 8mg to zero.

At Thrive we offer a pathway of 8,7,6,5,4,3,2,1,0.75,0.5,0.25mg. As buprenorphine is quite potent, macro “jumps” of 2–4mg are deeply felt and often disastrous for the 8mg and below dosing. Big Pharma isn’t interested in helping you get off or offering a legitimate pathway. Clinical studies also demonstrate that the strips are not evenly made so even with “perfect cuts” no piece is equal to the other and you will feel super out of sorts trying this way. This is why the package inserts say to never cut the strips as they know this. And the tablets just flake apart so not a valid strategy unless chunky powder is your thing (kidding). The “troches” we make are evenly made, so cutting off quarters is utilized as a strategy in the tapers. It is also true that your body hates you at 3mg and below and doesn’t want to let you go. It is recommended to take 5–6 months to go from 8mg to 3mg. This means every month is 1mg lower for the dose. The final week of one dose you may want to cut off a little to approximate the lower dose you will jump to. If you have a difficult month, you can repeat the same dose for the next month. The holidays October thru Jan 1 are difficult enough so often not the best time for the final 3mg stretch.

When 3mg is reached, now is when the quarter-piece-off cutting strategy needs to be employed. Expect 6 months to transition down from 3mg so that your world stays intact and your dog still comes to you. As an approximate, the dosing is closer to 3.0, 2.75, 2.5, 2.25, 2.0, 1.75, 1.5, 1.25, 1.0, etc. Larger dosage drops of 0.5mg may mean experiencing mild withdrawal symptoms. But your provider will be writing for 3mg, 2mg, 1mg, 0.75mg, 0.5mg, and 0.25mg. As these are then quartered, the smallest dose you will “jump” from is 0.0625mg (one-fourth of the 0.25mg). It may be advisable to even consider CBD oils to help smooth the transitions and help with sleep.

You will need to be patient with the process for lasting success. Take the time required and necessary to travel this journey as real life is still going on around you. Having watched many walk this journey, it is fully possible. And some are glad to have tapered down to a lower dose and may choose to stay at that dose for years. The running joke is that if zombies came when you were at 24mg, the jump would hurt too much. So if at 2mg when the apocalypse happened the jump isn’t so far.

We are here to help you and help with the strategy. We want you to be your best self and to continue to thrive in your life. We are honored to be part of your recovery story.

Dr Steve