When not to taper off of Buprenorphine or MAT

Oct 24, 2023

Sirisat Khalsa, MD

When not to taper off of Buprenorphine or MAT

Buprenorphine, a medication commonly used in the treatment of opioid addiction, has been a lifesaver for many individuals on their journey to recovery. While tapering off buprenorphine is a crucial step in some cases, it's equally essential to recognize that it's not the right choice for everyone. In this blog, we'll explore situations when it may be best to refrain from tapering off buprenorphine and instead continue with medication-assisted treatment.

1.Early Recovery

Early recovery is a critical and often tumultuous phase in the journey to sobriety. During this time, individuals are still adapting to a life without the opioids to which they were addicted. Attempting to taper off buprenorphine too soon can be risky, as the risk of relapse is notably higher. In such cases, the stability provided by buprenorphine can be a valuable tool in maintaining abstinence.

I usually recommend that my patients wait to consider coming off MAT until they are stable in housing, relationships, jobs, etc. I like them to consider waiting 6 months to 2 years minimum.  This decision is best made with your doctor. 

2. History of Frequent Relapses or Overdoses

Some individuals have a history of multiple relapses before finding success with buprenorphine maintenance. If someone has struggled with repeated relapses, it may be wise to continue the medication until they have achieved a more extended period of sustained recovery. Buprenorphine can act as a safety net during this time, providing stability and reducing the risk of relapse.

Research shows that coming off of buprenorphine or Suboxone increases the risk of overdoses.  If someone has had multiple overdoses in the past, they maybe at increased risk of additional overdoses in the future.

3. Co-occurring Mental Health Disorders

Many individuals struggling with addiction also deal with co-occurring mental health disorders, such as depression, anxiety, or post-traumatic stress disorder. Buprenorphine can offer not only relief from opioid cravings but also help stabilize mood and alleviate symptoms of these mental health issues.

For those with co-occurring disorders, the decision to taper should be made carefully. Removing the support of buprenorphine prematurely can increase the risk of exacerbating mental health symptoms and lead to relapse.

4. Ongoing Risk Factors

Certain life circumstances and risk factors may warrant the continuation of buprenorphine maintenance. These risk factors can include being in environments where opioids are readily available, having a history of associating with individuals who use drugs, or living in areas with high drug availability. In such situations, the support provided by buprenorphine can be vital in preventing relapse.

5. Lack of a Comprehensive Support System

Recovery from opioid addiction is more than just medication; it often requires a robust support system. Individuals without access to such support may not be suitable candidates for tapering off buprenorphine. A strong support system can include family and friends, therapy, counseling, and participation in support groups. Without these elements in place, the risks associated with tapering off buprenorphine can increase significantly.

6. Individual Preferences

Recovery should always be a personalized journey. Some individuals may have the desire and readiness to taper off buprenorphine, while others may not. It is crucial to honor an individual's choice regarding their recovery path. In many cases, people may find that long-term buprenorphine maintenance provides them with the stability they need to rebuild their lives and remain drug-free.


Tapering off buprenorphine is a significant decision that should be made with careful consideration of an individual's unique circumstances. While it is a positive step for many on their recovery journey, it's not the right choice for everyone.

There are situations where it is best to continue buprenorphine maintenance, especially during early recovery, for those with a history of frequent relapses, individuals dealing with co-occurring mental health disorders, those facing ongoing risk factors, and those lacking a comprehensive support system.

Ultimately, the goal of buprenorphine maintenance is to support individuals in achieving lasting recovery from opioid addiction. Whether one chooses to taper or not, the focus should always be on promoting a healthy, drug-free life and respecting each person's unique path to sobriety. It is essential that the decision to taper off buprenorphine is made with the guidance of healthcare professionals who can provide expert advice and support throughout the process.