Home > Discontinuing methadone and buprenorphine: a review and clinical challenges.

Zweben, Joan E and Sorensen, James L and Shingle, Mallory and Blazes, Christopher K (2021) Discontinuing methadone and buprenorphine: a review and clinical challenges. Journal of Addiction Medicine, 15, (6), pp. 454-460. doi: 10.1097/ADM.0000000000000789.

External website: https://journals.lww.com/journaladdictionmedicine/...

This paper offers a review and recommendations for clinicians working with patients interested in discontinuing opioid agonist treatment. As buprenorphine/naloxone has gained widespread acceptance for opioid addiction, many treatment providers and patients have a range of hopes and expectations about its optimal use. A surprising number assume buprenorphine/naloxone is primarily useful as a medication to transition off illicit opioid use, and success is partially defined by discontinuing the medication. Despite accumulating evidence that a majority of patients will need to remain on medication to preserve their gains, clinicians often have to address a patient's fervent desire to taper. Using the concept of "recovery capital," our review addresses (1) the appropriate duration of opioid agonist treatment, (2) risks associated with discontinuing, (3) a checklist that guides the patient through self-assessment of the wisdom of discontinuing opioid agonist treatment, and (4) shared decision making about how to proceed.

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