How do you approach weaning patients off of buprenorphine?  

I have found using injectable extended release buprenorphine (XR-BUP) as a good way to help patients taper off SL buprenorphine in a means much more tolerable than trying to taper SL buprenorphine. We published a case series on this approach (Ritvo et al., PMID 32925232) and subsequently another cas...

I do it very slowly. I had several patients who tried to do it within weeks or within 2 months and failed miserably. I usually advise people to reduce their current dosage by no more than 10% every month. It is a lengthy and difficult task, but the rate of success is much b...

I have txed over 2K folks with suboxone. If a patient takes 24 mgs/day, I taper by 4 mgs at a time until we get to 16 mgs/day. Then I taper by 2 mgs at a time until we get to 1/2 mg (0.5 mgs) Buprenorphine/day. Then I taper by 1 mg at a time, by switching to the 2/0.5 mg size. I try and get the pati...

I have a group of patients on sublingual daily doses of 2/0.5 mg or less (e.g., some quarter the 2 mg dose) and are happy there. They see me once every 2-3 months and they are in full remission and have a recovery that they are satisfied with. It is unfortunate that the US does not have the 0.4 mg s...

When transitioning to a lower dose, the patient can find it helpful to alternate doses for 2-4 weeks. For example, if someone is tapering from 12 mg to 10 mg daily, I encourage them to take 12 mg and 10 mg on alternating days for two weeks before settling into a dose of 10 mg daily. 

I think variable schedules certainly can be helpful. Let's not forget the group of patients who do not seem to have too much difficulty smoothly coming off of suboxone with flexible withdrawal schedules, in which a patient may hold the dose, go up or down whenever it is necessary to forestall intole...