Transcript Opiate Pharmacology

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
1. No longer needed to prevent relapse to heroin use (you
won’t know until you try)
Involuntary
1. Buprenorphine not effective (e.g., heroin use continuing at
level similar to pre-buprenorphine dosing)
2. Intolerable office behavior (e.g., drug dealing to other
patients)
Discontinuation of Psychosocial and
buprenorphine Treatment
• Generally a bad idea to discontinue both at once
• Discontinue buprenorphine treatment then
psychosocial treatment
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
• If patient starts having inter-dose opiate
withdrawal symptoms, divide dosage to twice or
three times daily