What are the guidelines for tapering Suboxone (buprenorphine/naloxone) by 5 points?

From the Guidelines

Tapering off Suboxone (buprenorphine/naloxone) should be done gradually under medical supervision, with a recommended reduction of 10% per month or slower, to minimize withdrawal symptoms and risks 1. When considering a 5-point tapering plan, it's essential to prioritize individualized tapering plans based on patient goals and concerns.

• A gradual approach is crucial to minimize withdrawal symptoms, such as anxiety, insomnia, muscle aches, and cravings.
• The taper may take several months or years, depending on the opioid dosage and individual patient factors.
• Regular check-ins with a healthcare provider are essential to adjust the plan based on the patient's response.
• Adjunctive medications like clonidine for blood pressure/anxiety, over-the-counter pain relievers for discomfort, and sleep aids may help manage symptoms.
• Clinicians should collaborate with patients on the tapering plan, including decisions on the tapering rate and when pauses in the taper might be warranted 1.
• It's also important to note that longer duration of previous opioid therapy might require a longer taper, and tapers of 10% per month or slower are likely to be better tolerated than more rapid tapers 1.
• Clinicians should remain alert to signs of and screen for anxiety, depression, and opioid misuse or opioid use disorder that might be revealed by an opioid taper and provide treatment or arrange for management of these comorbidities 1.

From the Research

Tapering Suboxone (Buprenorphine/Naloxone)

There are no specific guidelines provided in the studies for tapering Suboxone by 5 points. However, the studies discuss various methods of tapering and transitioning from buprenorphine, including:

• Microdose induction of buprenorphine 2, 3, 4
• Using extended-release buprenorphine injection to discontinue sublingual buprenorphine 5
• Overlapping full opioid agonist use with buprenorphine induction 4

Key Findings

• Tapering off buprenorphine can be challenging due to intolerable withdrawal symptoms 5
• Microdose induction of buprenorphine may be a safe and effective way to avoid opioid withdrawal and uncontrolled pain 2
• The Bernese method, which involves gradual induction of buprenorphine overlapping with full agonist use, may be associated with better tolerability and acceptability in some patients 4

Considerations

• Patients attempting to taper off buprenorphine should be informed about the difficulty involved and be monitored closely for signs of instability 6
• Program policies that support both tapering attempts and indefinite maintenance are important for patient success 6