How to Taper off Subutex Without Withdrawal

Buprenorphine (Subutex) is prescribed as an addiction-management tool for individuals undergoing treatment for substance use disorders linked to opioid and opiate use. The drug reduces cravings without creating the nasty aftermath of further dependence. For this reason, some people remain on Subutex indefinitely to help prevent relapse. However, sometimes, it might be necessary to stop Subutex: in these cases, it is important to slowly taper off the drug to avoid withdrawal symptoms.

Tapering off Subutex

Almost no one wishes to endure the kind of painful withdrawal that occurs when stopping a drug cold turkey. Fortunately, withdrawal symptoms are mitigated by slowly decreasing your Subutex dose — or tapering off Subutex. When withdrawal is eased, or at the very least is manageable, the detox can proceed unimpeded. This can lead to a more comfortable withdrawal experience and help prevent cravings and relapse.

Types of Opioid Tapering Methods

Several opioid tapering methods exist, including direct, substitute and titration. However, these methods are not created equally. While some methods, like direct tapering, are common and often medically recommended, titration tapers are not recommended and should be avoided.

Direct Tapering

In a direct taper, an opioid’s dose is slowly decreased over time until it can be safely stopped. A doctor will monitor you through a direct taper, letting you know when to reduce your Subutex dose and how long you should take the new one before further decreasing it. A direct taper is the most straightforward way of tapering the drug.

Substitute Tapering

In a substitute taper, a short-acting opioid may be converted to an alternate, longer-acting drug, which is then tapered. Although this can be useful with short-acting opioids to prevent withdrawal symptoms, Subutex is long-acting, meaning a substitute taper is less useful.

Titration Tapering

Titration tapering is not recommended. In a titration taper, you mix the opioid with water and drink decreasing amounts of the mixture every day. However, most opioids, including Subutex, do not completely dissolve in water, making the dose unpredictable. 

Why Consider Tapering vs. Stop Subutex Cold Turkey?

A Subutex withdrawal can be extremely uncomfortable. Subutex is a long-acting drug, so its withdrawals can also be long-lasting. To put that in perspective, quitting a short-acting opioid — such as heroin — can result in a 10-day-long withdrawal. These withdrawals are arguably more painful, but some consider Subutex withdrawals worse, given the extended timeframe.

If an individual decides to forgo a Subutex taper schedule and quit the medicine cold turkey, they can expect withdrawal symptoms to begin 12–48 hours after the final dose. Physical symptoms continue for up to 20 days and may be replaced by cravings or depression. These psychological side effects contribute to the likelihood of relapse. A full medical detox with abundant support and structure in a clinical setting is recommended.
Luckily, tapering off Subutex will almost always be done in the presence of medical professionals. These rehabilitation experts will develop an appropriate Subutex taper chart personalized to each patient’s unique needs.

Common Opioid Withdrawal Symptoms

Withdrawal symptoms are deeply uncomfortable and can feel overwhelming. Some people even quit their detox attempts due to uncontrolled withdrawal symptoms, which include:

• Muscle aches 
• Insomnia
• Runny eyes and nose
• Sweating
• Yawning
• Enlarged pupils
• Abdominal cramps
• Diarrhea
• Goosebumps
• Nausea or vomiting
• Agitation
• Anxiety 

Side Effects of Subutex Opioids Tapering

When tapered under the advice of a medical professional, Subutex tapering should have minimal — if any — side effects. The point of a taper is to slowly ease your body off the drug over time. If you experience side effects, this may be a sign that your taper is moving too quickly. In these cases, your doctor can pause or slow your taper to allow your body to adjust to a dose decrease.

Can Tapering Your Subutex Opioids Intake Reduce Withdrawal Symptoms?

A slow, steady taper of Subutex should reduce your risk of withdrawal symptoms. The goal of a taper is to avoid withdrawal symptoms, increasing your ability to complete detox. As such, a Subutex taper moves slowly to minimize or eliminate withdrawal symptoms.

How Long Does It Take to Taper off Opioids?

The duration of an opioid taper can vary from person to person and is highly individualized. While some people may be able to tolerate a quick opioid taper, others may require a longer one to avoid withdrawal symptoms. In general, a person who takes a higher dose of opioids and has been taking them for a long time may need a longer taper than someone who takes a lower dose and has only been taking them for a short time.

Subutex Tapering Schedule

After completing any previous opioid treatment, tapering off Subutex may follow suit. By their very nature, tapers are incremental and gradual beasts. They must be undertaken slowly for fear of awakening dormant withdrawal symptoms that eagerly wait at the surface for any slip-ups. No two Subutex taper charts look exactly the same because each patient will have different biological, emotional and psychological needs. A chart can be months long if necessary. An example of one such schedule may be:

• Starting Subutex Dosage Before Treatment: 20 mg/day
• Day one: Reduce to 12 mg/day
• Day six: 12 mg/day to 8 mg/day
• Day 11: 4 mg/day
• Day 16: 2 mg/day
• Day 24: 1.50 mg/day
• Day 31: 1 mg/day
• Day 39: 0.75 mg/day
• Day 45: 0.50 mg/day
• Day 51: 0.25 mg/day
• Day 56: 0.13 mg/day

With proper guidance, grit and a dash of good fortune, a Subutex taper will go off without a hitch, and patients will be free to reap the benefits of recovery.

How The Recovery Village Uses Subutex Opioids Tapering

At The Recovery Village, we prescribe buprenorphine products as medically appropriate and can help you wean off Subutex in a supportive environment. We approach recovery from a holistic perspective and are with you every step of the way. Starting with medical detox to help cleanse you of Subutex and continuing through rehab, we are invested in your long-term recovery. Don’t wait: contact us today to see how we can help.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more