Slow tapering from methadone maintenance in a program encouraging indefinite maintenance
Abstract
Longitudinal studies have indicated that most opioid agonist-using patients are not able to successfully complete tapering attempts. Little is known, however, about tapering within a treatment environment that is supportive of indefinite agonist treatment and medication tapering. In this study, all records of patients beginning a slow methadone taper were reviewed (N = 30). No patient successfully completed methadone tapering. Four patients (13.3%) successfully switched to buprenorphine/naloxone, one of whom tapered off buprenorphine/naloxone. Three patients (10%) were continuing their taper at the study's end. One patient transferred to another program, one was administratively discharged, and one had his taper stopped for mishandling doses. The remaining patients (n = 20, 66.7%) stopped their tapers for the following reasons: feeling unstable/withdrawal symptoms (n = 4, 13.3%), drug use/positive urinalysis results (n = 12, 40%), psychiatric instability (n = 3, 10%), and pain management (n = 1, 3.3%). Only one patient prematurely left treatment secondary to a failed taper attempt. Patients attempting tapers should be informed about the difficulty involved and be monitored closely for signs of instability. For a few patients, a taper to a lower methadone dose and a switch to buprenorphine/naloxone are obtainable. Program policies that support both tapering attempts and indefinite maintenance are described in this article.
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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 [6]
More explicit application of these principles to tapering regimens might improve the ability of patients to achieve cessation, particularly during the challenging final dose reductions, especially given that fear of withdrawal symptoms is one of the most common barriers to discontinuation.
“More explicit application of these principles to tapering regimens might improve the ability of patients to achieve cessation, particularly during the challenging final dose reductions, especially given that fear of withdrawal symptoms is one of the most common barriers to discontinuation.6,36”
From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [6]
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 [6]
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- Authors
- Calsyn, D. A., Malcy, J. A., & Saxon, A. J.
- Affiliations
- VA Puget Sound Health Care System (US)
- University of Washington (US)
- ORCID
- Saxon, Andrew J.
- Venue
- Journal of Substance Abuse Treatment
- Publisher
- Elsevier BV
- Published
- 2006-03
- Volume
- 30
- Issue
- 2
- Pages
- 159-163
- ISSN
- 0740-5472 (ISSN-L)
- OpenAlex
- W2031007413
- Cited by
- 55
- References
- 12
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 6 · 2020: 1 · 2019: 6 · 2018: 5 · 2017: 1 · 2016: 3 · 2015: 3 · 2014: 3 · 2013: 5 · 2012: 5
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Substance Abuse Treatment (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Alcohol and Drug Abuse Institute, University of Washington
- Center for Substance Abuse Treatment
- 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
- opioid use disorder, opioid substitution therapy, buprenorphine/naloxone, treatment retention, withdrawal symptoms, relapse, medication-assisted treatment
- MeSH terms
- Adult, Buprenorphine, Drug Administration Schedule, Female, Heroin Dependence, Humans, Male, Mental Health Services, Methadone, Middle Aged, Naloxone, Narcotic Antagonists, Substance Withdrawal Syndrome, Program Development
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