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Cited by 23Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPain Management and Opioid Use

Tapering off and returning to buprenorphine maintenance in a primary care Office Based Addiction Treatment (OBAT) program

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Weinstein, Zoe M., Gryczynski, Gabriela, Cheng, Debbie M., Quinn, Emily, Hui, David, Kim, Hyunjoong W., Labelle, Colleen, Samet, Jeffrey H.·2018·Drug and Alcohol Dependence
DOI 10.1016/j.drugalcdep.2018.05.010PMC PMC6139651
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Abstract

Background Guidelines recommend long-term treatment for opioid use disorder including the use of buprenorphine; however, many patients desire to eventually taper off. This study examines the prevalence and patient characteristics of patients that voluntarily taper off buprenorphine.Methods This is a 12-year retrospective cohort study of adults on buprenorphine in a large urban safety-net primary care practice. The primary outcome was completion of a voluntary buprenorphine taper, which was further characterized as a medically supervised or unsupervised taper. The secondary outcome was re-engagement in care after taper. Descriptive statistics and estimated proportions of both taper completion and re-engagement in treatment were calculated using Kaplan-Meier estimates.Results The study sample included 1308 patients with a median follow-up time of 316 days; 48 patients were observed to taper off buprenorphine during the study period, with an estimated proportion of 15% (95%CI: 10%-21%) based on Kaplan Meier analyses. Less than half of the tapers, 45.8% (22/48), were medically supervised. Thirteen of the 48 patients subsequently, re-engaged in buprenorphine treatment (estimated proportion 61%, 95%CI: 27%-96%), based on Kaplan-Meier analyses with median follow-up time of 490 days.Discussion Despite the fact that many patients desire to discontinue buprenorphine, a minority had a documented taper. Among those who tapered, more than half did so unsupervised by the clinic and a majority of those who tapered off returned to buprenorphine treatment within two years. As many patients are unable to successfully taper off buprenorphine, the medical community must work to address any barriers to long-term maintenance.

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Crossref · 10.1016/j.drugalcdep.2018.05.010

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  • Most longitudinal studies have found that patients on opioid agonists are not able to successfully complete tapering attempts.

    “Nevertheless, most longitudinal studies have found that patients on opioid agonists are not able to successfully complete tapering attempts.6–8”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [7]

    The Discussion (page unavailable) reports that only an estimated 15% of patients had a documented buprenorphine taper over 12 years, and 61% of those who tapered re-entered treatment. The Introduction (page unavailable) also describes completed methadone tapers as rare. But this study did not measure success among patients who attempted to taper, and its discussion of prior research does not establish what most longitudinal studies found. (LLM, conf=0.85)

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  • In general, the success rates of medically supervised opioid withdrawal are low.

    “In general, the success rates of medically supervised opioid withdrawal are low.6,7,33”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [7]

    The Discussion reports that only an estimated 15% of patients in this buprenorphine maintenance program had a documented taper, and 61% of those who tapered re-entered treatment. The Results say fewer than half of the completed tapers were medically supervised, but do not give a success rate specifically for supervised withdrawal. This single-program finding supports the general concern about low success, not the claim's broader scope or its supervised-withdrawal qualifier. (LLM, conf=0.83)

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Authors
Weinstein, Z. M., Gryczynski, G., Cheng, D. M., Quinn, E., Hui, D., Kim, H. W., Labelle, C., & Samet, J. H.
Affiliations
  • Boston University (US)
  • Kaiser Permanente (US)
Corresponding author
Weinstein, Zoe M.
ORCID
Venue
Drug and Alcohol Dependence
Publisher
Elsevier BV
Published
2018-08
Volume
189
Pages
166-171
ISSN
0376-8716 (ISSN-L)
DOI
10.1016/j.drugalcdep.2018.05.010
PMC
PMC6139651
OpenAlex
W2809003548
Cited by
23
References
33
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 6 · 2019: 4
FWCI
2.85
Type
journal article
Language
en
Open access
Licence
Locations
  • Drug and Alcohol Dependence (acceptedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Drug Abuse (R25DA0123582, T32AI052074)
  • National Institute of Allergy and Infectious Diseases (1UL1TR001430)
  • National Center for Advancing Translational Sciences
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 use disorder, tapering, re-engagement in care, long-term maintenance, primary care, safety net health care, patient characteristics
MeSH terms
Adult, Buprenorphine, Female, Follow-Up Studies, Humans, Male, Middle Aged, Narcotic Antagonists, Opioid-Related Disorders, Primary Health Care, Retrospective Studies, Cohort Studies, Substance Abuse Treatment Centers, Behavior, Addictive, Treatment Outcome, Withholding Treatment, Opiate Substitution Treatment

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