Few Patients Receiving Buprenorphine Taper Off; Most of Those Who Do Return to Treatment

Office-based buprenorphine is an effective treatment for opioid use disorder; the current standard of care is to continue it indefinitely. Some patients express a desire to eventually taper off; others experience external pressures to do so. However, data are scant on the frequency and success of tapering off. In this single-site, retrospective cohort study, researchers reviewed 12 years of office-based addiction treatment data including 1308 patients with a median follow-up of 316 days to determine the proportion who tapered off of buprenorphine, describe their characteristics, and determine the proportion that returned.

• During the full follow-up period of 2361 days, 48 patients tapered off of buprenorphine. Using Kaplan-Meier proportion estimates, which account for censored participants (those lost to follow-up or at end of the study), 15% tapered off of buprenorphine.
• Patients who underwent a supervised taper were engaged in treatment longer (median 774 days versus 433 days), had lower prescribed dosages (45% prescribed <4 mg/day versus 19%), and were more likely to be employed or a student (52% versus 24%), compared with those who underwent an unsupervised taper.
• Most of the patients (61%) who tapered off of buprenorphine returned to treatment. Most of them (77%) had undergone an unsupervised taper.

Comments: This study shows that a small proportion of patients receiving buprenorphine taper off and most return to treatment. This supports treating opioid use disorder as a chronic condition and continuing with treatment indefinitely without placing arbitrary time limits or end-points.

Jarratt Pytell, MD† & Darius A. Rastegar, MD

† Contributing editorial intern and Addiction Medicine Fellow, Johns Hopkins Medicine

Reference: Weinstein ZM, Gryczynski G, Cheng DM, et al. Tapering off and returning to buprenorphine maintenance in a primary care Office Based Addiction Treatment (OBAT) program. Drug Alcohol Depend. 2018;189:166–171.