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Short-term Buprenorphine for Methadone withdrawal?

When does a short-term Buprenorphine taper work to walk away with next to no withdrawal symptoms when off of it? You would think that, even though it's only a partial agonist, it still hits opiate receptors so you would be back at day 1 of withdrawal after discontinued use of Buprenorphine. I would like to use a short-term 14-21 day suboxone taper to come off of 30mg methadone daily for 4 yrs. I have been in methadone withdrawal for one week. I understand that even after the taper I will still feel some discomfort from the Methadone still but would taking the suboxone restart the withdrawal cycle to day 1? If not could you also answer the above question as to why it wouldn't? Thank you!

Male | 36 years old
Medications: Albuterol
Conditions: Asthma

2 Answers

AddictionMedicineSpecialist|AddictionMedicineAddictionMedicineSpecialist
Never. Switching to Suboxone is reasonable if you have been sober on methadone 30mg QD for 4 yrs. Tapper off of Suboxone slowly and gradually to avoid withdrawal symptoms and limit risk of relapse.
Your question is a little unclear, but I'll tell you what I know. In many respects buprenorphine and methadone are quite similar. Both are long-acting opioids with proven effectiveness in treating opioid addiction. Buprenorphine is safer and has fewer side effects. If you work with a good addiction medicine MD, it's generally not hard to switch from methadone to buprenorphine. Either medication is highly effective.

Because of persistent withdrawal lasting weeks or months, methadone is notoriously difficult to taper and stop, although surprisingly many people do manage to get off it without too much trouble. The hardest part is coming off the last, lowest dose, i.e., 5-15 mg/day. Buprenorphine has similar issues but in general is somewhat easier to stop than methadone. If you worked with a skilled addiction specialist, you could certainly taper and stop buprenorphine. But assume it will take weeks or months. One potential issue is that buprenorphine is usually a pretty good antidepressant, so you may have some depression or anxiety coming off it. People just feel better on buprenorphine.

Why in the world do you want to stop methadone?The risk of relapse is extremely high when people stop maintenance therapy with either drug. Both drugs are safe and effective for many years. Often, people decide to stop when they're tired of being sober, or if a friend or relative convinces them maintenance therapy is just another "addiction" and they need to stop (not true!).

I've come to regard opioid replacement treatment as something you're on forever, certainly 5-10 years or more. How do you know it's safe to stop taking it? When you've achieved full adult function: stable relationships (ideally including marriage or other long-term committed relationship). You have a career, not just a job. You've bought a house or have a similar stable living arrangement. There's just not a lot of drama in your life. Life is good!
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