Boulder Care

Tapering Buprenorphine

This content is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information contained herein should not be used for diagnosing or treating a health condition, and those seeking medical advice or guidance should consult with a licensed and qualified healthcare provider. Always seek the advice of a qualified healthcare provider regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have learned here or elsewhere.

If you think you may have a medical emergency, call 911 or go to the nearest emergency department immediately. No physician-patient or provider-patient relationship is created by this website or its use. Boulder Care makes no representations, express or implied, with respect to the information provided herein or to its use.

Stopping Buprenorphine: What to Expect

Deciding to taper off buprenorphine is a big step, and it’s important to do it in a way that feels safe, supported, and right for you. There is no “perfect” approach, your care team will work with you to create a plan that fits your goals and your body.

Are You Ready?

Before starting a taper, we want to make sure things feel steady in your recovery. Being "ready" is different for everyone but can mean things like:

  • Feeling more confident in your recovery
  • Having few to no cravings
  • Having support available

What Happens to Your Brain?

Think of your brain like a control center. Buprenorphine fits into special “spots” in your brain. This helps you feel okay and helps stop cravings so you’re less likely to use opioids.

Over time, your brain gets used to having buprenorphine there every day.

When you start taking less buprenorphine, your brain needs time to reset. It has to learn how to make its own "feel-good" signals again. This takes time, and that’s okay!

What if you Taper too Fast?

If the dose is lowered too quickly, your body may not have enough time to adjust. Tapering too fast can lead to things like:

  • Anxiety
  • Restlessness
  • Body aches
  • Trouble sleeping
  • Cravings
  • Feeling more upset emotionally

This happens because the brain is trying to catch up and adjust to the change.

How Tapering Works

"Taper or Tapering" means lowering your dose a little bit at a time. Most successful tapers can take weeks, months, or even longer to finish but it is different for everyone.

Slower tapers are often more comfortable and more successful.

Why slower is better

A slow taper gives your brain and body time to adjust. Even small dose changes can make a big difference in how you feel.

It takes time for the opioid receptors or “spots” in your brain to start working like they used to without medication.

A slow taper is not about keeping you on buprenorphine if you feel ready to stop. It is about giving your brain time to heal, lower unwanted symptoms, and support your recovery.

Why skipping doses is generally not preferred

Even though buprenorphine stays in your body for several days after taking a dose, skipping doses can still make your brain feel up and down.

Skipping doses can cause withdrawal symptoms, more cravings, and mood changes, and may feel harder than a steady taper.

It is much better to take a smaller amount every single day. This keeps your brain steady and calm while it learns to reset.

It’s okay to pause

Tapering is not a race. If you feel bad, you can stop at your current dose for a while. You can even go back up if you need to. Your safety and comfort are the most important things!

What if I change my mind?

That’s completely okay! Many people stay on buprenorphine for a long time, and that’s a safe option. You can pause your taper and start again when you feel ready. It is always your choice!

Example Taper Plan

We lower your dose one small step at a time.

  • Step 1: If you take 24 mg, we might try 22 mg or 20 mg first.
  • Step 2: We see how you feel. You might stay at this dose for a few weeks.
  • Step 3: If you feel good, we take another small step down.

Remember, dose changes are always based on how you are feeling!

How Boulder will support you

You don’t have to do this alone! Your Boulder care team is right here with you. We can:

  • Change or adjust the plan based on how you feel
  • Give you medicine to help with withdrawal symptoms if you need them
  • Check in with you often to see how you are doing

References

  1. Substance Abuse and Mental Health Services Administration. (2021). Medications for opioid use disorder (Treatment Improvement Protocol 63). U.S. Department of Health and Human Services.https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document
  2. American Society of Addiction Medicine. (2020). National practice guideline for the treatment of opioid use disorder: 2020 focused update. https://www.asam.org/quality-care/clinical-guidelines/national-practice-guideline
  3. World Health Organization. (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. https://www.who.int/publications/i/item/9789241547543
  4. National Institute on Drug Abuse. (2023). Medications to treat opioid use disorder research report. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-use-disorder
  5. Kampman, K., & Jarvis, M. (2015). American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. Journal of Addiction Medicine, 9(5), 358–367. https://doi.org/10.1097/ADM.0000000000000166
  6. Ling, W., Hillhouse, M., Domier, C., Doraimani, G., Hunter, J., Thomas, C., … Annon, J. (2009). Buprenorphine tapering schedule and illicit opioid use. Drug and Alcohol Dependence, 106(2–3), 188–193. https://doi.org/10.1016/j.drugalcdep.2009.07.009

Questions, concerns, or feedback?

You can send a message to your Care Team in the app with non-urgent questions or feedback, or call us at 888-316-0451.

See all articles >