Keywords

buprenorphine, taper, opioid use disorder

Abstract

Opioid use disorder (OUD) is increasing in incidence in the United States. Buprenorphine is the mainstay of medication-assisted treatment for OUD. Nurse practitioners play an essential role in solving the opioid epidemic and are increasingly relied on to prescribe buprenorphine. Even though buprenorphine is considered a long-term therapy, many patients request to taper off the drug. Evidence suggests that tapering from buprenorphine is frequently unsuccessful and remains as a challenge. The purpose of this article is to provide the best available evidence regarding the taper of buprenorphine in patients with OUD. Considering a buprenorphine taper should begin by evaluating if the patient is a good candidate, specifically if their maintenance dose of buprenorphine is less than 8 mg/day. This evaluation should also include assessment of the patient’s withdrawal expectation. Evidence suggests that a longer buprenorphine taper duration combined with naltrexone leads to better results compared to shorter tapers without naltrexone. Ancillary medications and counseling should be made available to patients as a component of the tapering protocol. Tapering from buprenorphine is difficult but following current evidence gives patients the best likelihood of success.