This is a common question that often comes up with any patient that is maintained on Suboxone treatment to control their opioid addiction and an important topic to address. The truth of the matter is that there is no right or wrong answer and everyone is going to follow a slightly different path on their road to recovery. What matters most is that you are involved in a comprehensive treatment program that provides counseling and other resources to help support you on this journey that often involves many stumbles and roadblocks along the way. You need to find a Suboxone doctor that will not judge or punish you for your mistakes but instead takes these opportunities to lift you up and encourage you because unfortunately addiction is a lifelong chronic relapsing medical condition that will always affect you even once you've tapered off Suboxone.
What If I Want To Taper
About half of my patients are what I consider chronic long term users of Suboxone that either have no intention of tapering off Suboxone at this time or have tried to taper in the past and have not done well. The other half of my patients eventually want to taper off Suboxone completely and are just using it as a tool to achieve their end goal. While it is not ideal to have to be dependent on a daily medication to maintain sobriety we feel that this is definitely better than the alternative of what could happen if one does not have Suboxone to help control their cravings. And the newest guidelines from all the major medical societies no longer dictate a recommended time limit for treatment with Buprenorphine and realize that tapering is an individual decision that should not be taken lightly. Factors to take into account when considering tapering include:
Employment, engagement in mutual help programs, or involvement in other meaningful activities.
Sustained abstinence from opioid and other drugs during treatment.
Positive changes in the psychosocial environment.
Evidence of additional psychosocial supports.
Persistent engagement in treatment for ongoing monitoring past the point of medication discontinuation.
Even when all these conditions are met it can still prove difficult to taper completely off Suboxone, especially at the lower doses. However, others have no problem whatsoever. Regardless of if you want to maintain on Suboxone or eventually taper studies have shown that longer treatment tends to be more successful and beneficial than short-term treatment. That is why I usually recommend at least a minimum of 6-12 months of maintenance therapy before tapering so that you can adequately address some of the bullet points mentioned above and get a good psychosocial support group in place. And even once you've tapered off if you do end up relapsing you need to get back into treatment right away with your Suboxone doctor and not be ashamed or consider yourself a failure. There is no shame in asking for help and if it takes going to a Suboxone clinic to get back on track then that is what you need to do. You can also consider other options such as a methadone clinic which provides slightly more structure due to the daily visits or Vivitrol instead of Suboxone.