Is Suboxone Maintenance More Effective Than Tapering?

By Zachary Siegel 11/24/15

The debate rages on...

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An ancient contention within the recovery community is whether or not opioid users should be on maintenance doses of drugs such as Suboxone.

One camp argues it’s better to taper off, because otherwise you’re replacing one drug for another. The other sees daily doses of Suboxone as another pathway toward recovery.

A recent randomized clinical trial published in JAMA Internal Medicine concluded: “Tapering is less efficacious than ongoing maintenance treatment in patients with prescription opioid dependence who receive buprenorphine therapy in primary care.”

The results of this study urge people to avoid tapering. Patients who tapered were more likely to test positive for illicit opioid use than patients who receive ongoing maintenance doses. Patients in the taper group were also less likely to be abstinent.

"Buprenorphine taper should be used sparingly, if at all, in primary care treatment of patients dependent on prescription opioids," the authors of the study wrote.

The researchers invoke the current prescription opioid crisis as motivating their work.

"In the U.S., there has been an increase in the number of individuals addicted initially and, in some cases, exclusively to prescription opioids, and some of these individuals exclusively use prescription opioids that maintain their dependence," Dr. David Fiellin, professor of investigative medicine and public health and co-author of the paper, told Medscape Medical News.

Dr. Fiellin explained to Medscape Medical News that the majority of those who become dependent on prescription opioids first sought them out recreationally. This point is critical, because legitimate pain patients are finding it increasingly difficult to receive their medication because the fear of abuse is rampant among the medical community.

"A small proportion of these individuals are those who may have initiated their opioid use because of an acute or perhaps chronic pain complaint ... for instance, a broken bone or a kidney stone, or some kind of trauma," Dr. Fiellin said. "They initiate opioid use because of pain but continue their opioid use because of the euphoria that they derive from that."

Back to the great debate, those on maintenance doses fared better in the trial than the taper group. Of course, it will still rage on.

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.