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Discontinuing Buprenorphine. Donald R. Wesson, MD. Words to use and not use. Use “Discontinuation” or “Tapering” Don’t use “detoxification” because it implies that buprenorphine is toxic. Have a Well-defined Reason for Discontinuation. Voluntary

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discontinuing buprenorphine

Discontinuing Buprenorphine

Donald R. Wesson, MD

words to use and not use
Words to use and not use
  • Use “Discontinuation” or “Tapering”
  • Don’t use “detoxification” because it implies that buprenorphine is toxic
have a well defined reason for discontinuation
Have a Well-defined Reasonfor Discontinuation

Voluntary

  • No longer needed to prevent relapse to heroin use (you won’t 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)
discontinuation of psychosocial and buprenorphine treatment
Discontinuation of Psychosocial and buprenorphine Treatment
  • Generally a bad idea to discontinue both at once
  • Discontinue buprenorphine treatment then psychosocial treatment
rate of taper
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
dosing strategy
Dosing Strategy
  • If patient starts having inter-dose opiate withdrawal symptoms, divide dosage to twice or three times daily
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