Importance: Retention in buprenorphine therapy is associated with a lower risk of opioid overdose. Nevertheless, many patients discontinue treatment, and there is limited evidence to guide buprenorphine tapering.

Question: Among people receiving buprenorphine maintenance therapy and undergoing a taper, what prescribing characteristics are associated with opioid overdose?

Findings: In this cohort study of 5774 individuals undergoing a buprenorphine taper, a longer time to taper initiation (≥1 year vs <1 year), a lower mean rate of taper (≤2 mg per month and >2 to ≤4 mg per month vs >4 mg per month), and a lower percentage of days during which the dose was decreasing (≤1.75% vs >3.50% of taper days) were significantly associated with a reduced risk of opioid overdose. Taper duration was not significantly associated with overdose.

Meaning: Buprenorphine tapers undertaken after at least 1 year of therapy, those with a slower rate of taper, and a lower percentage of days during which the dose was decreasing were associated with a significantly lower risk of opioid overdose, regardless of taper duration.