Discontinuing Methadone and Buprenorphine: A Review and Clinical Challenges

J Addict Med. 2021 Nov-Dec;15(6):454-460. doi: 10.1097/ADM.0000000000000789.


This paper offers a review and recommendations for clinicians working with patients interested in discontinuing opioid agonist treatment. As buprenorphine/naloxone has gained widespread acceptance for opioid addiction, many treatment providers and patients have a range of hopes and expectations about its optimal use. A surprising number assume buprenorphine/naloxone is primarily useful as a medication to transition off illicit opioid use, and success is partially defined by discontinuing the medication. Despite accumulating evidence that a majority of patients will need to remain on medication to preserve their gains, clinicians often have to address a patient's fervent desire to taper. Using the concept of "recovery capital," our review addresses (1) the appropriate duration of opioid agonist treatment, (2) risks associated with discontinuing, (3) a checklist that guides the patient through self-assessment of the wisdom of discontinuing opioid agonist treatment, and (4) shared decision making about how to proceed.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Buprenorphine* / therapeutic use
  • Humans
  • Methadone / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Opiate Substitution Treatment
  • Opioid-Related Disorders* / drug therapy


  • Analgesics, Opioid
  • Narcotic Antagonists
  • Buprenorphine
  • Methadone