I want to get off Suboxone, now what?
A lot of people begin worrying about getting off of buprenorphine medications—including Suboxone (buprenorphine/naloxone)—before they even begin their treatment program. It’s one of the topics that comes up often when people call us for more information before starting treatment and during their orientation appointment. Here are some of the common questions we encounter about tapering off Suboxone:
How long should I expect to take Suboxone before beginning my taper?
Studies suggest that tapering off of buprenorphine too quickly can lead to an increased risk of relapse. For this reason, many providers recommend a considered, slow taper after long-term use (18-24 months is common). This is not to keep you “trapped on meds,” but to give you the best chance at a stable, healthy recovery. Taking a buprenorphine medication over this length of time gives you the opportunity to overcome the physiological dependency (the physical addiction of your body) and the psychological dependency (the learned response of your mind and emotions). Your brain can adjust to the reduction in artificial dopamine surges, your body can heal from the effect opioids were having on it, and you have time to develop new coping methods and life skills so that you will be less likely to seek out opioids in the future. This plan—a long period of buprenorphine treatment (some call it “maintenance”), followed by a careful taper—has been shown to promote long-term recovery, reduce the risk of withdrawal, and prevent relapse.
However, your body and your life belong to you. If you want to discontinue taking a buprenorphine medication like Suboxone sooner, talk to your provider. They can work with you to create a plan to taper your dose on a shorter timeline. If you have not been in treatment long enough to develop physical and psychological stability, your provider may caution you that tapering isn’t wise. But in the end, it is your choice.
My family thinks I should just stop.
Your family cares and probably believes they know best, but in most cases, they are not the ones who should be making medical decisions on your behalf. There is a lot of stigma around medication-assisted treatment, in the general public and in recovery circles (especially 12-step-based groups), and even among some doctors. To counter that stigma and provide a more accurate viewpoint, consider sharing information about medication-assisted treatment from trusted sources, like governmental and medical agencies. Workit Health created a free downloadable guide for friends and families that you could send them.
Even if they really wish you could be completely medication-free, the fact is that stopping cold turkey leads to withdrawal, which often spurs people to start using again. If your loved ones want the best for you, let them know that continuing to follow medical advice about your tapering process is what’s best for you.
What if I start the process and it’s not working for me? Can I bring my dose back up?
Yes, many people discover that they’re not as ready to taper as they had assumed. When this happens, they frequently decide to resume taking a higher dose and postpone tapering until a future date.
The smallest dose available is 2mg, but going from 2mg to zero feels like too big of a drop.
The last step off of buprenorphine can be mentally stressful as well as sometimes physiologically difficult. But you can make that step less steep! Talk to your medical provider about your concerns and any withdrawal symptoms you have so that they can help you make a plan for overcoming that last step.
One common suggestion is to split the strips to create smaller doses. Your provider can help you plan how to divide your strips and schedule them. For example, your provider might suggest you split your 2mg film, that you change the time of day you take your dose, or that you space your dose out so that you’re skipping days in between taking it. It all depends on your needs.
Your provider may also suggest strategies for dealing with any withdrawal symptoms that come up. These strategies might include prescription or over-the-counter medications, mild exercise, or behavioral health support. You can also talk with your provider about options for after you have completed your taper, including a non-opioid medication like naltrexone and ongoing behavioral health support like coaching, recovery groups, or counseling.
Do I have to taper off?
No. Many people find the dose that works best for them and just maintain that level. We think of this as similar to people who depend on insulin to manage their diabetes, or blood pressure medication to manage hypertension.
Because it comes up frequently, I will add that we do not consider this to be trading one addiction for another. Addiction is characterized (and diagnosed) by the effects it has on a person’s life and lack of control. This includes using a substance despite knowing it is hurting one’s health or relationships, using more than intended, developing increasing tolerance, using in risky situations, failing to meet responsibilities because of use, etc. Dependence has none of these characteristics. The only thing dependence and addiction have in common is the likelihood of withdrawal symptoms.
For a deeper look at the answers and more, check out the Tapering Off Suboxone panel discussion on our YouTube channel, in which two Workit Health providers and a counselor talked in detail about these topics.