Approach to Tapering:
1. Assess the Current Buprenorphine Dose:
- ≤ 4 mg/day: Most patients experience no withdrawal or cravings.
- Give 100 mg Sublocade once a month for 2 months → then stop.
- 5–12 mg/day: Start with 300 mg once or twice, then 100 mg once or twice, then stop.
- 16–24 mg/day: Use 300 mg for 2–3 months, then taper to 100 mg for 1–2 months, then stop.
2. Duration of Use:
- Most patients need 2–4 shots total, depending on dose and response.
- Some may need up to 5, especially if psychological dependence is strong.
Why It Works:
- The medication builds up in the system, offering a smooth taper with fewer cravings and withdrawals.
- It eliminates the daily ritual of taking a pill, helping patients break the mental habit of needing a substance to feel normal.
- Patients transition to a mindset of “I’m okay without taking anything”.
About the Injections:
- Sublocade: Long-standing option with a longer half-life.
- Brixadi: Newer, with a shorter half-life but less painful, smaller volume, multiple injection sites, and no refrigeration required.
- Both are highly effective; Brixadi is increasingly favored for its convenience.
Final Thoughts:
- These extended-release formulations have revolutionized how patients taper off Suboxone.
- In clinical experience, over 100 patients have successfully come off buprenorphine using this approach.
- Even for patients who initially struggle, restarting at a lower dose later often leads to success.
