How Do You Taper Off Suboxone?

Tapering off Suboxone involves gradually using smaller amounts of medication until you’re taking none at all. 

If you’re ready to stop taking your prescription medication, ask your doctor how to do so safely and effectively. Following a few tried-and-true steps from others could be smart too.

Why Consider a Suboxone Taper?

Suboxone is safe for long-term use, and some people take the medication indefinitely to keep their opioid use disorder (OUD) under control.[1] But you might need to quit your treatment program. 

These are three reasons people cite when requesting a Suboxone taper:

1. Your OUD is under control. Your opioid cravings are gone, you've been in recovery for many years, and you don't think you need medication.
2. You're dealing with side effects. While most people tolerate Suboxone, some patients will have persistent bothersome side effects, including nausea, GI upset, dizziness, sexual dysfunction, or headaches.
3. Your health or life has changed. Pregnancy, an upcoming surgery, or significant changes in life circumstances are other reasons people sometimes discontinue Suboxone.

Know that you're not required to quit taking medication that helps you. But if you're ready to quit, your doctor can help you plan. 

A Typical Suboxone Taper Schedule 

Experts say people rarely develop significant withdrawal symptoms when they lower their dose gradually.[2] Your doctor can help you find a schedule that's right for you. 

‍Your reduction rate can vary depending on how much buprenorphine is in your daily Suboxone dose.[2] If you take:

• More than 16 mg: Reduce your buprenorphine by 4 mg every 1–2 weeks
• Between 8 mg and 16 mg: Reduce your buprenorphine by 2–4 mg every 1–2 weeks
• Less than 8 mg: Reduce your buprenorphine by 2 mg every 1–2 weeks

If you're taking 16 mg of buprenorphine in your Suboxone each day, your schedule might look like this:

• Week 1: Reduce your dose to 12 mg.
• Week 2: If no withdrawal symptoms appear, reduce your dose to 8 mg. 
• Week 3: If no withdrawal symptoms appear, reduce your dose to 4 mg.
• Week 4: If no withdrawal symptoms appear, stop your dose.

If you notice significant withdrawal symptoms or you’re tempted to relapse to drugs, your taper is moving too quickly. Stay at your current dose and talk with your doctor. 

Medications to Help You Taper Successfully 

A too-quick taper can leave you feeling very sick. Keep solutions on hand to use when you need them, including these:

• Imodium: This medication helps to prevent diarrhea
• Pepto Bismol: This helps with GI upset
• Mild painkillers: Aspirin or an NSAID help with headaches and muscle cramps.

Your doctor can also use prescription medications, including naloxone, to ensure that your taper works as successfully as possible.

How to Taper Off Suboxone 

You probably started taking Suboxone in a tapering format. You took one dose, watched for symptoms, and took another if you felt sick.[3] As you taper off Suboxone, you follow the same process in reverse.

A taper process sounds easy enough. You take a smaller dose every few days until you take none. But a little planning can help you feel much more comfortable and in control. Follow these steps:

Determine Your Dose

How much Suboxone are you taking right now? How many milligrams are in each dose, and how often do you take the drug? 

Your prescription should include all the necessary details. If not, ask your doctor or pharmacist.

Set Your Schedule

Are you facing a firm deadline, or do you have time to let your body adjust more slowly? In general, the longer the taper, the more comfortable you will feel.

Share Your Plans

Tell your friends, family members, and support groups that you are tapering off Suboxone. Ask them to help you and encourage you. If the process gets tough, turn to them for support.

Work With Your Doctor

Can you set up and pull off your own Suboxone taper? Maybe. But it’s best to let a doctor guide you through the process. Your doctor can help you understand and anticipate side effects and prepare adequately for this transition.

What Are the Risks of Quitting Suboxone?

Before you think of quitting, consider whether or not you're truly ready to do so. Talk to your treatment team and support network to assess whether it's the best decision for your long-term recovery.

There is no shame in taking Suboxone for long periods or even indefinitely when necessary. Addiction is a chronic, relapsing condition. If your medication helps you stay sober, keep taking it.

These are a few known risks of quitting Suboxone. 

Withdrawal Symptoms

Symptoms of withdrawal from opioids are not life-threatening, but they can be extremely uncomfortable. They can cause people to relapse toward repeated drug use to ease the painful symptoms.

If you quit taking Suboxone too soon, you could develop uncomfortable symptoms like nausea and vomiting. Your brain cells are not yet healed. 

Relapse 

Using Suboxone for longer periods is associated with a better chance of recovery.[4] The medication alleviates chemical imbalances in your brain, allowing you to focus on your recovery. Each dose helps you to avoid discomfort and cravings, making you less likely to relapse.

If your cravings become overwhelming, it's probably easier to find street drugs like heroin than medications like Suboxone. The next slip you have could lead to a life-threatening overdose. 

How to Decide if a Taper Is Right for You

Your doctor can be especially helpful in discussing why you want to taper off Suboxone. If you want to quit because of difficult side effects, your doctor could suggest a different formulation or dose. You could still get the help you need without abandoning a medication that is helping to keep you from relapse.

Sources

1. Impact of Long-Term Buprenorphine Treatment on Adverse Health Care Outcomes in Medicaid. Health Affairs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531057/. May 2020. Accessed January 2023.
2. Dosing Guide for Optimal Management of Opioid Dependence. Suboxone. https://www.naabt.org/documents/Suboxone_Dosing_guide.pdf. Accessed January 2023.
3. OUD Induction Handout. British Columbia Ministry of Health. https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/oud-induction-handout.pdf. Accessed January 2023. 
4. Extended Suboxone Treatment Substantially Improves Outcomes for Opioid-Addicted Young Adults. National Institutes of Health. https://www.nih.gov/news-events/news-releases/extended-suboxone-treatment-substantially-improves-outcomes-opioid-addicted-young-adults. November 2008. Accessed January 2023.