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Cited by 176Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPain Management and Opioid Use

Discontinuation of Buprenorphine Maintenance Therapy: Perspectives and Outcomes

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Bentzley, Brandon S., Barth, Kelly S., Back, Sudie E., Book, Sarah W.·2015·Journal of Substance Abuse Treatment
DOI 10.1016/j.jsat.2014.12.011PMC PMC4382404
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Abstract

Buprenorphine maintenance therapy (BMT) is increasingly the preferred opioid maintenance agent due to its reduced toxicity and availability in an office-based setting in the United States. Although BMT has been shown to be highly efficacious, it is often discontinued soon after initiation. No current systematic review has yet investigated providers' or patients' reasons for BMT discontinuation or the outcomes that follow. Hence, provider and patient perspectives associated with BMT discontinuation after a period of stable buprenorphine maintenance and the resultant outcomes were systematically reviewed with specific emphasis on pre-buprenorphine-taper parameters predictive of relapse following BMT discontinuation. Few identified studies address provider or patient perspectives associated with buprenorphine discontinuation. Within the studies reviewed providers with residency training in BMT were more likely to favor long term BMT instead of detoxification, and providers were likely to consider BMT discontinuation in the face of medication misuse. Patients often desired to remain on BMT because of fear of relapse to illicit opioid use if they were to discontinue BMT. The majority of patients who discontinued BMT did so involuntarily, often due to failure to follow strict program requirements, and 1 month following discontinuation, rates of relapse to illicit opioid use exceeded 50% in every study reviewed. Only lower buprenorphine maintenance dose, which may be a marker for attenuated addiction severity, predicted better outcomes across studies. Relaxed BMT program requirements and frequent counsel on the high probability of relapse if BMT is discontinued may improve retention in treatment and prevent the relapse to illicit opioid use that is likely to follow BMT discontinuation.

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  • 28% of physicians working in addiction cited difficulties with tapering opioids because of a lack of tablets at lower doses.

    “Indeed, 28% of physicians working in addiction cited difficulties with tapering opioids because of a lack of tablets at lower doses. 36”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [36]

    In Results §3.2, the paper reports that 28% of surveyed physicians cited difficulty starting a buprenorphine taper because lower-dose tablets were unavailable. The claim broadens this finding to tapering opioids generally, which the passage does not establish. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • 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 [36]

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Research works printed but not linked: 1

  1. SAMHSA 2011 Medication-Assisted Treatment for Opioid Addiction: 2010 State Profiles Substance Abuse and Mental Health Services Administration 1 163 22514849

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Authors
Bentzley, B. S., Barth, K. S., Back, S. E., & Book, S. W.
Affiliations
Medical University of South Carolina (US)
ORCID
Venue
Journal of Substance Abuse Treatment
Publisher
Elsevier BV
Published
2015-05
Volume
52
Pages
48-57
ISSN
0740-5472 (ISSN-L)
DOI
10.1016/j.jsat.2014.12.011
PMC
PMC4382404
OpenAlex
W2022774038
Cited by
176
References
80
Citations by year
2026: 12 · 2025: 18 · 2024: 18 · 2023: 24 · 2022: 19 · 2021: 22 · 2020: 21 · 2019: 16 · 2018: 10 · 2017: 7 · 2016: 4 · 2015: 5
FWCI
0.83
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Substance Abuse Treatment (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (F30 DA035065, T32 GM008716, K12 HD055885, R25 DA020537)
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
treatment discontinuation, opioid use disorder, relapse, provider perspectives, patient perspectives, medication misuse, treatment retention, addiction severity, office-based opioid treatment
MeSH terms
Analgesics, Opioid, Buprenorphine, Humans, Opioid-Related Disorders, Withholding Treatment

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