The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: A review
Open accessAbstract
Background The association between buprenorphine taper duration and treatment outcomes is not well understood. This review evaluated whether duration of outpatient buprenorphine taper is significantly associated with treatment outcomes.Methods Studies that were published in peer-reviewed journals, administered buprenorphine as an outpatient taper to opioid-dependent participants, and provided data on at least one of three primary treatment outcome measures (opioid abstinence, retention, peak withdrawal severity) were reviewed. Primary treatment outcomes were evaluated as a function of taper duration using hierarchical linear regressions with pre-taper maintenance duration as a cofactor.Results Twenty-eight studies were reviewed. Taper duration significantly predicted percent of opioid-negative samples provided during treatment, however pre-taper maintenance period predicted percent participants abstinent on the final day of treatment. High rates of relapse were reported. No significant association between taper duration and retention in treatment or peak withdrawal severity was observed.Conclusion The data reviewed here suggest taper duration is associated with opioid abstinence achieved during detoxification but not with other markers of treatment outcome. The reviewed studies varied widely on several parameters (e.g., frequency of urinalysis testing, provision of ancillary medications) that may influence treatment outcome and thus could have interfered with the ability to identify relationships between taper duration and outcomes. Future studies evaluating opioid detoxification should utilize rigorous experimental methods and report a wider range of outcome measures in order to help advance our understanding of the association between taper duration and treatment outcomes.
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One systematic review found that withdrawal symptoms commonly peaked after buprenorphine dose had been tapered below 2 mg.
“One systematic review found that withdrawal symptoms commonly peaked after buprenorphine dose had been tapered below 2 mg. 34”
From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [34]
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BackgroundBreen, C. L., Harris, S. J., Lintzeris, N., Mattick, R. P., Hawken, L., Bell, J. R., Ritter, A. J., Lenné, M. G., & Mendoza, E. (2003) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(03)00071-1 · Cited by 53 · cited 1× · see citing works
“Five of the studies reviewed here (Breen et al., 2003; Resnick et al, 2001; Summers and Stone, 2002; White et al., 2001; Williams et al., 2002) utilized a flexible dosing strategy, yet only 1 reported the percent of samples that were opioid abstinent (23%; Williams et al.”
BackgroundStrain, E. C., Harrison, J. A., & Bigelow, G. E. (2011) · Clinical Pharmacology & Therapeutics · doi:10.1038/clpt.2010.352 · Cited by 52 · cited 1× · see citing works
“, Suboxone soluble film strip) and sustainedrelease products are becoming available that may have unique excretion patterns (Ling et al., 2010; Strain et al., 2011; White et al., 2009).”
BackgroundSelf-citationRidge, G., Gossop, M., Lintzeris, N., Witton, J., & Strang, J. (2008) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2008.09.007 · Cited by 50 · cited 1× · see citing works
“The use of buprenorphine for opioid detoxification is increasing (Gowing and Ali, 2006; Helm et al., 2008; Horspool et al., 2008; Ridge et al., 2008), yet there is little standardization of buprenorphine detoxification designs.”
BackgroundTreatment for Opioid Dependence
Rounsaville, B. J., & Kosten, T. R. (2000) · JAMA · doi:10.1001/jama.283.10.1337 · Cited by 49 · see citing works
Barriers to and Need for Alcohol Services for Women in Rural Populations
Booth, B. M., & McLaughlin, Y. S. (2000) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2000.tb02093.x · Cited by 45 · see citing works
Outpatient Opiate Detoxification Treatment with Buprenorphine
Diamant, K., Fischer, G., Schneider, C., Lenzinger, E., Pezawas, L., Schindler, S., & Eder, H. (1998) · European Addiction Research · doi:10.1159/000018953 · Cited by 44 · see citing works
Three Methods of Opioid Detoxification in a Primary Care Setting
O’Connor, P. G., Carroll, K. M., Shi, J. M., Schottenfeld, R. S., Kosten, T. R., & Rounsaville, B. J. (1997) · Annals of Internal Medicine · Cited by 43 · see citing works
Strang, J., & Gossop, M. (1990) · Addictive Behaviors · doi:10.1016/0306-4603(90)90054-2 · Cited by 42 · cited 1× · see citing works
“Magnitude decrease has been associated with differential outcomes following methadone detoxification, yet it is not clear this finding will generalize given buprenorphine’s unique pharmacological profile (Strang and Gossop, 1990).”
BackgroundAbstinence following detoxification and methadone maintenance treatment
Cushman, P. (1978) · The American Journal of Medicine · doi:10.1016/0002-9343(78)90691-5 · Cited by 37 · cited 1× · see citing works
“Similar relapse rates have been reported following detoxification from methadone maintenance, wherein approximately 17–37% of patients who complete detoxification remain abstinent from opioids 2 – 6 years later (Cushman, 1978; Gossop et al., 1986; Stimmel and Rabin, 1974; Stimmel et al., 1977).”
BackgroundOverdosage of buprenorphine: case report.
Cd, B. (1979) · PubMed · Cited by 37 · see citing works
Outpatient detoxification of the addicted or alcoholic patient.
Prater, C. D., Miller, K. E., & Zylstra, R. G. (1999) · PubMed · Cited by 36 · see citing works
White, R., Alcorn, R., & Feinmann, C. (2001) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(01)00149-1 · Cited by 36 · cited 3× · see citing works
“Five of the studies eviewed here (Breen et al., 2003; Resnick et al., 2001; Summers nd Stone, 2002; White et al., 2001; Williams et al., 2002) utilized a exible dosing strategy, yet only 1 reported the percent of samples hat were opioid abstinent (23%; Williams et al.”
BackgroundDistribution of Substance Abuse Treatment Facilities Across the Rural-Urban Continuum
Gale, J. A., & Mhs, J. D. L. (2007) · Cited by 34 · see citing works
The Ability to Remain Abstinent Upon Leaving Methadone Maintenance: A Prospective Study
Stimmel, B., & Rabin, M. (1974) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952997409011031 · Cited by 31 · cited 1× · see citing works
“Similar relapse rates have been reported following detoxification from methadone maintenance, wherein approximately 17–37% of patients who complete detoxification remain abstinent from opioids 2 – 6 years later (Cushman, 1978; Gossop et al., 1986; Stimmel and Rabin, 1974; Stimmel et al., 1977).”
BackgroundTreatment preferences of opiate-dependent patients
Luty, J. (2004) · Psychiatric Bulletin · doi:10.1192/pb.28.2.47 · Cited by 31 · cited 1× · see citing works
“First, some opioid users refer detoxification to maintenance (Apple et al., 2004; Luty, 2004; into et al., 2010; Zacny et al., 2003).”
BackgroundIncreasing prevalence of prescription opiate misuse over time among rural probationers
Havens, J. R., Oser, C. B., & Leukefeld, C. G. (2007) · Journal of Opioid Management · doi:10.5055/jom.2007.0047 · Cited by 31 · cited 2× · see citing works
“Finally, when maintenance availability is imited, a circumstance that is likely to occur in rural areas that re struggling with high rates of prescription opioid dependence, etoxification is a valuable and necessary treatment option (Booth nd McLaughlin, 2000; Cicero et al., 2007; Cunningham et al., 2007; ortney and B…”
Background2006 National Survey of Substance Abuse Treatment Services
(2007) · PsycEXTRA Dataset · doi:10.1037/e432292008-009 · Cited by 31 · see citing works
Sigmon, S., Dunn, K., Badger, G., Heil, S., & Higgins, S. (2008) · Addictive Behaviours · doi:10.1016/j.addbeh.2008.11.017 · Cited by 30 · cited 2× · see citing works
“, 2001), and 7 studies reported that withdrawal severity peaked 3 to 15 days after the last dose was administered (Amass et al., 1994; Becker et al., 2001; Cameron et al, 2001; Lintzeris, 2002; Raistrick et al., 2002; Sigmon et al. 2009; White et al., 2001).”
BackgroundSelf-citationDawe, S., Griffiths, P., Gossop, M., & Strang, J. (1991) · British Journal of Addiction · doi:10.1111/j.1360-0443.1991.tb01858.x · Cited by 30 · cited 1× · see citing works
“flexible buprenorphine detoxification schedules, flexible dosing has been associated with poorer retention in treatment following methadone detoxification (Dawe et al., 1991).”
BackgroundThe place of detoxification in treatment of opioid dependence
Gowing, L., & Ali, R. L. (2006) · Current Opinion in Psychiatry · doi:10.1097/01.yco.0000218596.54054.a1 · Cited by 29 · see citing works
Raistrick, D., West, D., Finnegan, O. C., Thistlethwaite, G., Brearley, R., & Banbery, J. (2005) · Addiction · doi:10.1111/j.1360-0443.2005.01273.x · Cited by 28 · see citing works
Provider Satisfaction with Office-Based Treatment of Opioid Dependence: A Systematic Review
Becker, W. C., & Fiellin, D. A. (2006) · Substance Abuse · doi:10.1300/j465v26n01_02 · Cited by 27 · see citing works
Gross, A., Marsch, L., Badger, G., & Bickel, W. (2006) · Experimental and clinical psychopharmacology · doi:10.1037/1064-1297.14.2.148 · Cited by 26 · cited 1× · see citing works
“Second, what additional contribution will concomitant therapies (including CM) have on abstinence rates during and after detoxification? CM produced promising outcomes in the studies reviewed here, consistent with studies that have used CM with opioid-dependent patients (Bickel et al., 1997; Gross et al., 2006; Kosten…”
ResultWithdrawal from methadone maintenance. Impact of a tapering network support program.
Sorensen, J. L., Trier, M., Brummett, S., Gold, M. L., & Dumontet, R. (1992) · Journal of Substance Abuse Treatment · doi:10.1016/0740-5472(92)90006-a · Cited by 25 · see citing works
Buprenorphine tablet versus liquid: A clinical trial comparing plasma levels, efficacy, and symptoms
Chawarski, M. C., Moody, D. E., Pakes, J., O’Connor, P. G., & Schottenfeld, R. S. (2005) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2005.08.011 · Cited by 24 · cited 1× · see citing works
“dministered a wide variety of buprenorphine formulations that ay have different absorption and excretion patterns (Table 1; hawarski et al., 2005).”
BackgroundBuprenorphine dosing regime in the management of out‐patient heroin withdrawal
Lintzeris, N. (2002) · Drug and Alcohol Review · doi:10.1080/09595230220119309 · Cited by 23 · cited 2× · see citing works
“261 Opioid Suboxone 30 26 24 Y 4 Y Y Y NS 30c, 90 Lintzeris (2002) 18 Heroin Subutex 4 1 10.”
A Comparison of Clonidine and Buprenorphine in the Outpatient Treatment of Opiate Withdrawal
Fingerhood, M., Thompson, M. R., & Jasinski, D. R. (2001) · Substance Abuse · doi:10.1080/08897070109511459 · Cited by 23 · cited 1× · see citing works
“, 2002) and 2 retrospective comparisons with other treatment medications (Fingerhood et al., 2001; White et al., 2001).”
BackgroundKatz, E. C., Schwartz, R. P., King, S. D., Highfield, D. A., O’Grady, K. E., Billings, T., Gandhi, D. H., Weintraub, E., Glovinsky, D., Barksdale, W., et al. (2009) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990802585380 · Cited by 21 · cited 4× · see citing works
“Although there have been some scientific efforts to parametrically compare different buprenorphine taper durations (Amass et al., 1994; Katz et al., 2009; Ling et al., 2009; Woody et al., 2008), the results of these studies have been mixed and the majority of studies on this topic are uncontrolled reports of a single…”
BackgroundMethodInfluentialResnick, R. B., Galanter, M. S., Resnick, E., & Pycha, C. (2001) · Journal of Addictive Diseases · doi:10.1300/j069v20n02_06 · Cited by 20 · cited 2× · see citing works
“, 2007), 10 unrandomized evaluations (Becker et al., 2001; Diamont et al., 1998; Galanter et al., 2003; Katz et al., 2009; Lintzeris, 2002; Quigley et al., 1987; Resnick et al., 2001; Sigmon et al., 2009; Summers and Stone, 2002; Williams et al., 2002) and 2 retrospective comparisons with other treatment medications (…”
BackgroundGradual Dose Taper Following Chronic Buprenorphine
Becker, A. B., Strain, E. C., Bigelow, G. E., Stitzer, M. L., & Johnson, R. E. (2001) · American Journal on Addictions · doi:10.1080/105504901750227778 · Cited by 19 · cited 2× · see citing works
“Three studies used contingency management (CM), a behavioral intervention that provides monetary-based incentives for urinalysis-verified drug abstinence, to increase opioid abstinence (Amass et al., 1994; Becker et al., 2001; Marsch et al., 2005).”
BackgroundSelf-citationPost-Treatment Outcomes of Buprenorphine Detoxification in Community Settings: A Systematic Review
Horspool, M. J., Seivewright, N., Armitage, C. J., & Mathers, N. J. (2008) · European Addiction Research · doi:10.1159/000141641 · Cited by 18 · cited 1× · see citing works
“The use of buprenorphine for opioid detoxification is increasing (Gowing and Ali, 2006; Helm et al., 2008; Horspool et al., 2008; Ridge et al., 2008), yet there is little standardization of buprenorphine detoxification designs.”
BackgroundWright, N. M. J., Sheard, L., Tompkins, C. N. E., Adams, C. E., Allgar, V. L., & Oldham, N. S. (2007) · BMC Family Practice · doi:10.1186/1471-2296-8-3 · Cited by 17 · cited 1× · see citing works
“Overall, the above search terms resulted in 16 randomized trials (Amass et al., 1988; Bickel et al., 1988b; Blondell et al., 2010, Breen et al., 2003; Cameron et al., 2001; Gandhi et al., 2003; Gibson et al., 2003; Ling et al., 2005; Ling et al., 2009; Lintzeris et al., 2002; Marsch et al., 2005; O’Connor et al., 1997…”
BackgroundWhy do patients report transferring between methadone and buprenorphine?
WINSTOCK, A. R., Lintzeris, N., & Lea, T. (2009) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2009.00127.x · Cited by 11 · cited 1× · see citing works
“Buprenorphine may appeal to patients who are unwillng or unable to access methadone treatment, particularly those esiding in rural areas where access to methadone treatment may e limited (Apple et al., 2004; Becker and Fiellin, 2005; Cicero et al., 005; Havens et al., 2007; Fiellin, 2007; Korthius et al., 2010; Pinto…”
BackgroundCameron, D., Allen, D., & Galway, K. (2001) · Journal of Substance Use · doi:10.1080/146598901300271103 · Cited by 10 · see citing works
Short-Term Buprenorphine Maintenance
Galanter, M. S., Dermatis, H., Resnick, R. B., Maslansky, R. A., & Neumann, E. (2003) · Journal of Addictive Diseases · doi:10.1300/j069v22n03_04 · Cited by 8 · cited 1× · see citing works
“, 2007), 10 unrandomized evaluations (Becker et al., 2001; Diamont et al., 1998; Galanter et al., 2003; Katz et al., 2009; Lintzeris, 2002; Quigley et al., 1987; Resnick et al., 2001; Sigmon et al., 2009; Summers and Stone, 2002; Williams et al., 2002) and 2 retrospective comparisons with other treatment medications (…”
BackgroundBuphrenorphine: Detoxification After Maintenance Treatment
Quigley, A. J., Seow, S. S. W., Ilett, K. F., Dusci, L. J., Swensen, G., Harrison‐Stewart, A., & Rappeport, L. (1987) · Australian Drug and Alcohol Review · doi:10.1080/09595238780000021 · Cited by 5 · cited 1× · see citing works
“Quigley et al. (1987) 15 Heroin SL liquid 28 30 4 Y 10 NS Y Y NS NS”
BackgroundTreatment of Opioid Addiction in Physicians' Offices
Schnoll, S. H. (2001) · Journal of Addictive Diseases · doi:10.1300/j069v20n02_01 · Cited by 5 · see citing works
Williams, H., Remedios, A., Oyefeso, A. O., & Bennett, J. (2002) · Irish Journal of Psychological Medicine · doi:10.1017/s0790966700007114 · Cited by 5 · cited 2× · see citing works
“Five of the studies eviewed here (Breen et al., 2003; Resnick et al., 2001; Summers nd Stone, 2002; White et al., 2001; Williams et al., 2002) utilized a exible dosing strategy, yet only 1 reported the percent of samples hat were opioid abstinent (23%; Williams et al.”
BackgroundMethodSummers, Z., & Stone, S. (2002) · Journal of Substance Use · doi:10.1080/14659890210132135 · Cited by 4 · see citing works
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κ-opioid receptor/dynorphin system: genetic and pharmacotherapeutic implications for addiction
Butelman, E. R., Yuferov, V. P., & Kreek, M. J. (2012) · Trends in Neurosciences · doi:10.1016/j.tins.2012.05.005 · Cited by 194 · see citing works
“However, the clinical management of withdrawal from MOPr agonists, while necessary, is not sufficient to sustain a decrease in relapse risk over the medium or long term [30, 32].”
Discontinuation of Buprenorphine Maintenance Therapy: Perspectives and Outcomes
Bentzley, B. S., Barth, K. S., Back, S. E., & Book, S. W. (2015) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2014.12.011 · Cited by 176 · see citing works
“However, BMT maintenance period could be particularly important given that longer durations of BMT have been linked with better outcomes (Dunn et al., 2011).”
InfluentialGordon, A. J., Drexler, K. P. G., Hawkins, E. J., Burden, J. L., Codell, N. K., Mhatre-Owens, A., Dungan, M. T., & Hagedorn, H. (2020) · Substance Abuse · doi:10.1080/08897077.2020.1787299 · Cited by 138 · see citing works
Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice
Sigmon, S. C., Bisaga, A. M., Nunes, E. V., O’Connor, P. G., Kosten, T. R., & WOODY, G. E. (2012) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2011.653426 · Cited by 126 · see citing works
Self-citationMarsch, L. A., Moore, S. K., Borodovsky, J. T., Solhkhah, R., Badger, G. J., Semino, S. J., Jarrett, K., Condon, K. A. D., Rossettie, K., Vincent, P., et al. (2016) · Addiction · doi:10.1111/add.13363 · Cited by 97 · see citing works
“While buprenorphine has been established as an effective medication for adults with opioid use disorders, (28, 29) its safety and efficacy for youth is less well understood (26, 30) as research on buprenorphine treatment for youth has been limited.”
BackgroundHarrison, T. K., Kornfeld, H., Aggarwal, A. K., & Lembke, A. (2018) · Anesthesiology Clinics · doi:10.1016/j.anclin.2018.04.002 · Cited by 92 · see citing works
“By contrast, short-term use of opioid agonist therapy as part of a “detoxification protocol” is rarely effective.(6,7) Patients randomized to placebo withdrawal, compared with methadone or buprenorphine maintenance treatment, are 2 times to 4 times more likely to be dead at a year.”
BackgroundSigmon, S., Dunn, K., Saulsgiver, K., Patrick, M. E., Badger, G., Heil, S., Brooklyn, J., & Higgins, S. (2013) · JAMA psychiatry · doi:10.1001/jamapsychiatry.2013.2216 · Cited by 89 · see citing works
Self-citationHegmann, K. T., Weiss, M., Bowden, K., Branco, F., DuBrueler, K., Els, C., Mandel, S., McKinney, D. W., Miguel, R. V., Mueller, K. L., et al. (2014) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000000352 · Cited by 90 · see citing works
A Stage I pilot study of acceptance and commitment therapy for methadone detoxification
Stotts, A. L., Green, C., Masuda, A., Grabowski, J. G., Wilson, K. G., Northrup, T. F., Moeller, F. G., & Schmitz, J. M. (2012) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2012.02.015 · Cited by 79 · see citing works
Dunn, K. E., Huhn, A. S., Bergeria, C. L., Gipson, C. D., & Weerts, E. M. (2019) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1124/jpet.119.258004 · Cited by 74 · see citing works
“Several concomitant medications are commonly administered to manage emergent symptoms of acute withdrawal (Hillhouse et al., 2010; Dunn et al., 2011; Schuckit, 2016).”
BackgroundSelf-citationGoodman, D., Milliken, C. U., Theiler, R. N., Nordstrom, B. R., & Akerman, S. C. (2015) · Journal of Dual Diagnosis · doi:10.1080/15504263.2015.1104484 · Cited by 71 · see citing works
Jordan, C. J., Cao, J., Newman, A. H., & Xi, Z. (2019) · Neuropharmacology · doi:10.1016/j.neuropharm.2019.04.015 · Cited by 70 · see citing works
“28 studies suggested that buprenorphine taper duration (ranging from 0 to 365 days) is positively associated with varying degrees of abstinence (Dunn et al., 2011).”
BackgroundBisaga, A. M., Mannelli, P., Sullivan, M. A., Vosburg, S. K., Compton, P. A., WOODY, G. E., & Kosten, T. R. (2018) · American Journal on Addictions · doi:10.1111/ajad.12711 · Cited by 62 · see citing works
“For these patients, evidence largely suggests that a slow agonist taper provides superior outcomes to a rapid taper, although conflicting results have been reported.(39,79) Some patients, however, despite having been successfully treated with agonists long-term, may be unable to complete the taper and may have to resu…”
ResultClinical Management of Opioid Withdrawal.
Torres‐Lockhart, K. E., Lu, T. Y., Weimer, M. B., Stein, M. R., & Cunningham, C. O. (2022) · Addiction · doi:10.1111/add.15818 · Cited by 57 · see citing works
Opioid use disorder and the brain: a clinical perspective
Herlinger, K., & Lingford-Hughes, A. R. (2021) · Addiction · doi:10.1111/add.15636 · Cited by 61 · see citing works
LEVIN, F. R., Bisaga, A. M., Sullivan, M. A., Williams, A. R., & Cates‐Wessel, K. (2016) · American Journal on Addictions · doi:10.1111/ajad.12454 · Cited by 57 · see citing works
Efficacy of Tramadol Extended-Release for Opioid Withdrawal
Dunn, K. E., Tompkins, D. A., Bigelow, G. E., & Strain, E. C. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.1838 · Cited by 51 · see citing works
Self-citationGarcía‐Portilla, M. P., Bobes-Bascarán, T., Bascarán, T., Sáiz, P. A., & Bobes, J. (2012) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.12031 · Cited by 49 · see citing works
Initiating buprenorphine treatment for hospitalized patients with opioid dependence: A case series
Suzuki, J., DeVido, J. J., Kalra, I., Mittal, L. P., Shah, S. B., Zinser, J., & Weiss, R. D. (2015) · American Journal on Addictions · doi:10.1111/ajad.12161 · Cited by 42 · see citing works
Patient Perspectives Associated with Intended Duration of Buprenorphine Maintenance Therapy
Bentzley, B. S., Barth, K. S., Back, S. E., Aronson, G., & Book, S. W. (2015) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.04.002 · Cited by 38 · see citing works
“…2011) may be particularly important given that relapse rates after BMT discontinuation are very high (Bailey et al., 2013; Bentzley et al., 2015; Dunn et al., 2011;Horspool et al., 2008; Kornør et al., 2007), and some patients may underestimate their risk of relapsewith treatment…”
Discontinuing Methadone and Buprenorphine: A Review and Clinical Challenges
Zweben, J. E., Sorensen, J. L., Shingle, M., & Blazes, C. K. (2020) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000789 · Cited by 38 · see citing works
“A substantial subset of patients receiving buprenorphine/naloxone appear to achieve lasting rehabilitation, but discontinuing the medication is associated with relapse, overdose, and mortality.(10,11,12,13,14) Research into effective methods for encouraging patients to stay in treatment must continue, yet physicians,…”
BackgroundCharacterizing opioid withdrawal during double-blind buprenorphine detoxification
Dunn, K. E., Saulsgiver, K. A., Miller, M. E., Nuzzo, P. A., & Sigmon, S. C. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.02.033 · Cited by 32 · see citing works
“The additional posttaper week was included to permit examination of withdrawal in the days following the final buprenorphine dose, since several previous studies have reported a potential delayed onset of withdrawal following buprenorphine taper (see Dunn et al., 2011).”
BackgroundMethodInfluentialSelf-citationPredictors of Outcome after Short-term Stabilization with Buprenorphine
Hillhouse, M. P., Canamar, C. P., & Ling, W. (2012) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2012.08.016 · Cited by 33 · see citing works
Worley, M. J., Heinzerling, K. G., SHOPTAW, S. J., & Ling, W. W. (2017) · Addiction · doi:10.1111/add.13782 · Cited by 31 · see citing works
“The course of BUP–NLX treatment for opioid dependence often has a fixed duration, with the transition off opioid maintenance associated with elevated rates of relapse [33].”
Mésusage et dépendance aux opioïdes de prescription : prévention, repérage et prise en charge
Rolland, B., Bouhassira, D., Authier, N., Auriacombe, M., Martinez, V., Poloméni, P., Brousse, G., Schwan, R., Lack, P., Bachellier, J., et al. (2017) · La Revue de Médecine Interne · doi:10.1016/j.revmed.2016.12.024 · Cited by 29 · see citing works
Hui, D. S. C., Weinstein, Z., Cheng, D. M., Quinn, E. K., Kim, H. W., LaBelle, C. T., & Samet, J. H. (2017) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.05.010 · Cited by 29 · see citing works
Gordon, A. J., Saxon, A. J., Kertesz, S. G., Wyse, J. J. B., Manhapra, A., Lin, L. A., Chen, W., Hansen, J., Pinnell, D., Huynh, T., et al. (2023) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2023.109902 · Cited by 25 · see citing works
Dunn, K. E., Bergeria, C. L., Huhn, A. S., & Strain, E. C. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108212 · Cited by 22 · see citing works
Self-citationEvren, C., Karabulut, V., Can, Y., Bozkurt, M., Umut, G., & Evren, B. (2014) · Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology · doi:10.5455/bcp.20140310072258 · Cited by 22 · see citing works
Habibi, R., Nasrabadi, A. N., Shabani, M., & Amirreza, S. M. (2016) · international journal high risk behaviors & addiction · doi:10.5812/ijhrba.24421 · Cited by 19 · see citing works
“Interestingly, in five studies, only 30% of the participants had continued abstinence from drugs until the last day of treatment (29).”
BackgroundTreatments for opioid use disorder among pregnant and reproductive-aged women
Hand, D. J., Short, V. L., & Abatemarco, D. J. (2017) · Fertility and Sterility · doi:10.1016/j.fertnstert.2017.06.011 · Cited by 19 · see citing works
Worries About Discontinuing Buprenorphine Treatment: Scale Development and Clinical Correlates
Stein, M. D., Conti, M. T., Herman, D. S., Anderson, B. J., Bailey, G. L., Noppen, D. V., & Abrantes, A. M. (2019) · American Journal on Addictions · doi:10.1111/ajad.12884 · Cited by 19 · see citing works
Bertin, C., Delage, N., Rolland, B., Pennel, L., Fatseas, M., Trouvin, A., Delorme, J., Chenaf, C., & Authier, N. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.12.015 · Cited by 16 · see citing works
Ritvo, A. D., Calcaterra, S. L., & Ritvo, J. I. (2020) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000738 · Cited by 14 · see citing works
Predictors of induction onto extended-release naltrexone among unemployed heroin-dependent adults
Jarvis, B. P., Holtyn, A. F., Berry, M. S., Subramaniam, S., Umbricht, A., Fingerhood, M., Bigelow, G. E., & Silverman, K. (2017) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.04.012 · Cited by 13 · see citing works
“, 2010) and during outpatient buprenorphine-assisted detoxification (Dunn et al., 2011), and would not be eligible for XR-NTX.”
InfluentialHerlinger, K., & Lingford-Hughes, A. R. (2021) · BJPsych Advances · doi:10.1192/bja.2020.98 · Cited by 11 · see citing works
“Naltrexone is also often not offered in clinical practice; one review found that naltrexone was encouraged in only a minority of community bupre-norphine detox studies, with many reports not mentioning its use (Dunn 2011).”
Woodcock, E. A., Lundahl, L. H., & Greenwald, M. K. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2014.11.016 · Cited by 11 · see citing works
“A recent meta-analysis (Dunn et al., 2011) of 28 BUP treatment trials that culminated with outpatient dose tapering found that participant retention was modest (median: 65%, range: 4-100%), while urinalysis-verified opioid abstinence was low during maintenance treatment (median: 41%, range: 1-94%),…”
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Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model
Gustin, R. M., Nichols, J., & Martin, P. R. (2015) · Journal of Reward Deficiency Syndrome · doi:10.17756/jrds.2015-003 · Cited by 9 · see citing works
“These beliefs are centered on a misguided understanding, which assumes that if a patient stops taking the opioid, then they are cured; however, this is not supported by the available evidence concerning detoxification and abstinence based treatment [13-16].”
BackgroundRamsey, S. E., Rounsaville, D., Hoskinson, R., Park, T. W., Ames, E. G., Neirinckx, V. D., & Friedmann, P. (2016) · Substance Abuse: Research and Treatment · doi:10.4137/sart.s39067 · Cited by 8 · see citing works
Dunn, K. E., Fingerhood, M., Wong, C. J., Svikis, D. S., Nuzzo, P. A., & Silverman, K. (2014) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0034863 · Cited by 7 · see citing works
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Newer approaches to opioid detoxification
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“[26] Adjunct psychotherapy has been found to be linked to higher retention rates and lesser opioid use in patients undergoing detoxification.”
Buprenorphine in Maintenance Therapy
Phillips, K. A., & Preston, K. L. (2013) · Springer eBooks · doi:10.1007/978-1-4614-6974-2_11 · Cited by 4 · see citing works
Southard, M. T., Giannotti, G., Thakar, A., Willsey, T. R., Bailey, L. G., Salazar, F., Hentges, S. T., Quock, R. M., & Brown, T. E. (2025) · Scientific Reports · doi:10.1038/s41598-025-07937-z · Cited by 3 · see citing works
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Initiating buprenorphine treatment for hospitalized patients with opioid dependence: A case series
Suzuki, J., DeVido, J. J., Kalra, I., Mittal, L. P., Shah, S. B., Zinser, J., & Weiss, R. D. (2014) · American Journal on Addictions · doi:10.1002/ajad.12161.x · Cited by 3 · see citing works
Shulman, M., Provost, S. E., Ohrtman, K., Novo, P., Meyers-Ohki, S. E., Veldhuisen, P. C. V., Oden, N. L., Otterstatter, M. C., Bailey, G. L., Liu, D., et al. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107543 · Cited by 3 · see citing works
Badaras, R., Jovaiša, T., Lapinskienė, I., & Ivaškevičius, J. (2019) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000560 · Cited by 3 · see citing works
“Studies note the effectiveness of treatment with agonists and partial agonists in long-term detoxification and abstinence (Dunn et al., 2011; Wright et al., 2011; Sigmon et al., 2013; Schuckit, 2016).”
BackgroundSindt, J. E., & Jenkinson, R. H. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-48110-6.00018-1 · Cited by 2 · see citing works
Burmester, S., Krüger, C., Hällgren, J., Westman, J., & Franck, J. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06368-w · Cited by 1 · see citing works
“These calculations were based on an assumed proportion of abstinence of 0.30 [44, 66].”
InfluentialRay, A., Mancino, M. J., Thostenson, J. D., Guise, J. B., Hendrickson, H. P., Nunes, E. V., & Oliveto, A. H. (2025) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2025.2564757 · Cited by 1 · see citing works
“Buprenorphine withdrawal remains a frequent clinical challenge, particularly for individuals attempting to taper off the medication in outpatient settings (13).”
Bagshaw, A., Shah, S., Olchefske, I., Paterson, L. M., Crawford, M. J., & Lingford-Hughes, A. R. (2026) · Addiction · doi:10.1111/add.70482 · Cited by 1 · see citing works
“Several published reviews have explored optimum tapering schedules [16, 24] and the efficacy of pharmacological interventions to facilitate detoxification [25 – 27], so these studies were excluded.”
Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice
Feder, R. (2020) · American Journal on Addictions · doi:10.1111/ajad.13060 · Cited by 1 · see citing works
Supervised Withdrawal Opioid Use Disorder Treatments
Dunn, K. E., & Huhn, A. S. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197618431.013.24 · Cited by 1 · see citing works
Self-citationAbie Horowitz, M., Framer, A., Strang, J., & Taylor, D. (2025) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253251371504
Prescribing, Prescription Monitoring, and Health Policy
Gordon, A. J., Cochran, G., Smid, M. C., Manhapra, A., & Kertesz, S. G. (2019) · Current clinical psychiatry · doi:10.1007/978-3-030-16257-3_11
Ferguson, Y., Lavoie, S., Plessis-Bélair, M.-C., Wagner, V., Hudon, K., Goyer, M.-È., & Flores-Aranda, J. (2021) · Drogues santé et société · doi:10.7202/1085171ar
“…et ce, malgré les risques associés à ce type de pratiques, tels les rechutes, les infections, les surdoses et la mortalité (Bentzley et al., Tous droits réservés © Drogues, santé et société, vol. 19, n o 1-2, décembre 2021 134 2015 ; Bruneau et al., 2018 ; Dunn et al., 2011 ; Gandhi et al., 2003”
BackgroundChapter 54. Treatment of Substance Use Disorders
Sherman, B. J., Hartwell, K. J., McRae‐Clark, A. L., Herron, A., & Brady, K. T. (2024) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615375523.as54
Jhajharia, A., Saha, P., Mandal, P., & Ambekar, A. (2025) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_1084_24
“[17] Interestingly, the 33% drop-out rate in the current “real world” setting is comparable to previous more controlled studies on the inpatient population (36% [6] and 37% [8]) which might be due to flexible and long duration of tapering in the present study making outpatient withdrawal management…”
Teixeira, F. M. A. A., Krzanowski, J., Ilves, L., & Archer, J. R. H. (2025) · BMJ Case Reports · doi:10.1136/bcr-2025-268674
Renner, J. A., DeVido, J. J., & Kobrin, K. L. (2025) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9798894550862.lg05
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Jafari, S., Rahimi‐Movaghar, A., Noroozi, A., Malekifar, P., & Fotouhi, A. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1933443
- Authors
- Dunn, K. E., Sigmon, S. C., Strain, E. C., Heil, S. H., & Higgins, S. T.
- Affiliations
- Johns Hopkins University (US)
- University of Vermont (US)
- Corresponding author
- Dunn, Kelly E.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2011-12
- Volume
- 119
- Issue
- 1-2
- Pages
- 1-9
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC3205338
- OpenAlex
- W2004685297
- Cited by
- 65
- References
- 107
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 7 · 2019: 5 · 2018: 3 · 2017: 6 · 2016: 4 · 2015: 5 · 2014: 6 · 2013: 2 · 2012: 7
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (4k24da023186-10)
- National Institute on Drug Abuse (K24-DA023186, R01DA019989, T32DA007242, T32DA007209)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- buprenorphine, opioid detoxification, outpatient care, opioid use disorder, opioid abstinence, treatment retention, withdrawal severity, relapse
- MeSH terms
- Buprenorphine, Drug Administration Schedule, Humans, Narcotic Antagonists, Opioid-Related Disorders, Outpatients, Substance Withdrawal Syndrome, Treatment Outcome, Substance-Related Disorders
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