There can be a lot of pressure on folks in recovery from opioid use disorder to taper off Suboxone (buprenorphine/naloxone) quickly. Heck, we get Facebook and Instagram comments every day, accusing us of wrongdoing for NOT forcing our members to taper off their meds as quickly as possible.
But these commenters are wrong. Not only are they morally wrong for judging and interfering with other people’s recovery, but they are also factually wrong in suggesting that it’s healthier, smarter, or better to get off Suboxone as fast as they can. They’re wrong all the way around. Researchers, medical experts, and providers who treat substance use disorders all know that a short Suboxone treatment and a rushed taper are dangerous.
Why is a quick buprenorphine taper dangerous?
Suboxone is not a detox medication. I know that some treatment centers use it that way, but it’s not how it is intended to be used. Suboxone (like other buprenorphine/naloxone meds) is intended to be a treatment medication, relieving cravings and withdrawal symptoms so that people with opioid use disorder have the opportunity to break the patterns they’ve been stuck in. Breaking these patterns in how you think and behave can take time and often requires help. No one is going to develop new coping skills, identify their triggers, and rebuild their relationships, finances, and stability all in the course of a single week. (But given a longer treatment, it’s very possible.)
If you do a rapid Suboxone taper, you may be able to avoid the worst of your withdrawal symptoms, but you will likely still be subject to frequent and intense cravings. By having a short term of treatment, you won’t give yourself the time and space to build a stable recovery grounded on healthier behaviors.
Shorting your treatment time and rushing your taper can increase your risk of resuming use and overdosing. A 2022 study found that, “Buprenorphine tapers undertaken after at least 1 year of therapy, those with a slower rate of taper, and a lower percentage of days during which the dose was decreasing were associated with a significantly lower risk of opioid overdose, regardless of taper duration.” That is to say, staying on Suboxone for more than a year with a slow, planned taper was the safest option.
Cold turkey is even worse.
If a too-short Suboxone treatment with a too-fast taper is dangerous, quitting opioids cold turkey is even worse. Suddenly discontinuing opioids means that you will have withdrawal symptoms … and they will be pretty miserable. Along with feeling terrible, research has discovered that going through opioid withdrawal from quitting cold turkey makes it more likely that a person will resume opioid use and less likely that they will get treatment. With opioids, returning to use means being at increased risk of overdose.
It’s important to note that pregnant people are particularly warned against quitting opioids suddenly. The physical stress and fluctuations (and higher risk of overdose) put both parent and fetus in danger. Medication like Suboxone or methadone is the recommended treatment for all people with opioid use disorder, but especially for those who are pregnant.
Most providers recommend against stopping Suboxone at all.
You don’t have to taper off Suboxone at all. No matter what the angry Facebook comments suggest, I’m not saying this because I’m trying to trap you into a lifetime of medication. I’m saying this so that you know it’s an option. If your recovery is well supported by Suboxone, and you’re not experiencing distressing side effects that make you want to quit, most addiction doctors will recommend that you just keep taking it. Maintaining your medication will continue to relieve your cravings and withdrawal symptoms, so you can continue living a stable life as you heal from your opioid use disorder.
So why do people think they need to taper off Suboxone rapidly?
The most common reason I encounter for people promoting a quick taper is a stigma against treatment medications. This is often framed as “not wanting to swap one addiction for another.” People who take this tack often use the fact that Suboxone requires a taper in order to avoid withdrawal symptoms as a cornerstone of their argument.
Here’s what I tell those people: “Physical dependence isn’t the same thing as addiction, and Suboxone reduces the symptoms of addiction. Cravings decrease so you can focus on daily living, free of the opioids you were using. Part of the definition of addiction is “continued use despite harmful consequences,” and with Suboxone, people are often able to stop creating harmful consequences in their lives as they regain clarity of thought and self-control. This is the essence of recovery.”
Endangering your recovery and your life is not worth it just to “win” the race to get off Suboxone. You deserve the benefits you can get from real, long-term treatment.
If you do want to stop, plan a long, slow taper with your provider.
You’re in charge of your recovery and your life. If you have decided you want to stop Suboxone treatment, talk to your provider. They can help you make a taper schedule that will reduce your withdrawal symptoms and help you transition as safely as possible to the next phase of your treatment.