Discontinuing Buprenorphine Treatment
While there is a strong bias in many sectors of the treatment community for using buprenorphine for temporary symptom management, all existing evidence suggests that discontinuing buprenorphine treatment at any point increases relapse risk. Consider this chart from a five-year followup of buprenorphine and methadone treatment. At any point in the five years, persons on buprenorphine and methadone had significantly lower rates of opioid use and thereby significantly lower risk for accidental poisoning and death.
In this way, the medical management of opioid cravings is consistent with the medical management of other indicators of health risk such as hypertension and hypercholesterolemia. Medication works when you take it and stops working when treatment is discontinued.
Patients who ask to taper or discontinue their medication should be educated about the risk associated with this decision and be counseled to either continue medical treatment or taper very gradually, with careful attention to associated increases in drug cravings.