How to Taper Off Suboxone: A Survival Guide

"Fear is common and normal for a number of reasons, but the fear usually gives way to a sense of confidence and optimism when a taper is done correctly…Be patient."

Fear of relapse and withdrawals makes me terrified of coming off Suboxone.

Note: This article is not intended as a replacement for medical advice. This is merely the experience of 21 people interviewed by the author who have successfully tapered off buprenorphine-based medications (Suboxone, Zubsolv, Bunavail, Subutex, etc.) or significantly reduced their dose. Please consult your doctor before beginning a taper.

After two and a half years of taking Suboxone, I’ve decided that it’s time to start the tapering process. I don’t like having to rely on this little orange film strip each morning to get out of bed, the tidal wave of nausea, being constantly hot, the restless legs, and the constipation. This is an incredibly difficult decision because Suboxone has saved my life. Additionally, studies have demonstrated the effectiveness of Suboxone and found it’s reduced overdose death rates by 40 percent.

Some people decide that it is best for them to take Suboxone for life. Shannon has been taking 16 milligrams of Suboxone for 17 years and has no intention of tapering. She said: “I’m never getting off, why fix something that isn't broken? I love life now. I'm a great mother, wife, daughter, sister, aunt, and trustworthy friend to all those that know and love me. I have absolutely no shame being a lifer. I've been to the depths of hell and now I'm in heaven. I believe without subs, I would be dead.”

Like Shannon, fear of relapse and withdrawals makes me terrified of coming off Suboxone. I imagine waking up panicked and glazed in sweat, running to the bathroom to puke and worst of all, the black hole of depression and existential dread that is common with opioid withdrawal. These are common fears for people coming off opioid addiction treatment medications. In order to help others like me who are interested in tapering, I researched this topic and surveyed 21 people: 13 have successfully tapered off Suboxone and eight have significantly lowered their doses and are currently at or under six milligrams per day.

Slow Taper

Sixteen of 21 people I surveyed reported using a slow taper to come off or lower their dose. Dr. Jeffrey Junig of the Suboxone Talk Zone Blog suggests that the optimal dose to “jump” or quit taking Suboxone is .3 mg (about 1/3 of 1 mg).

Junig writes: “I have had many patients taper successfully off buprenorphine. Fear is common and normal for a number of reasons, but the fear usually gives way to a sense of confidence and optimism when a taper is done correctly…Be patient. Tapering by too much, or too quickly, causes withdrawal symptoms that lead to ‘yo-yos’ in dose.”

Amanda* agrees with Junig’s advice not to try to jump from too high of a dose. She said that when she jumped from 2 mg cold turkey it was “40 days of hell.”

To avoid a hellish experience like Amanda’s, Junig advises reducing your dose by 5% or less every two weeks or 10% every month. Sound confusing? Junig simplifies: Use scissors to cut half of an 8 mg film. Then cut half of that, then half again. Put the doses in a pill organizer so they don’t get lost or accidentally consumed by children or pets.

Holistic Remedies

There are a handful of holistic remedies that can help with the tapering process. Folks I surveyed said that yoga, meditation, and healthy eating are pillars of their recovery. Studies have confirmed the benefit of yoga for improving quality of life in those withdrawing from opioids as it alleviates anxiety, restless legs, insomnia, and even nausea.

Sarah said: “I tapered with a clean diet with digestible nutrient-dense food and smoothies and stayed hydrated. I got plenty of sun, used yoga and exercise too.”

Others recommended vitamins and other supplements including: L-Tyrosine, DLPA, Vitamin C, Omega 3 Fish Oil, and ashwagandha. They used melatonin for sleep and Kava tea for relaxation. (Consult your physician before taking any supplements. Even benign substances may interact with other medications or have unintended side effects.)

Marijuana

Four out of 21 people polled used marijuana to deal with the difficult side effects of tapering off Suboxone. Barry said: “I know that some people may not see marijuana as a way that should be used to taper, but for me I was desperate to try anything that worked. I consider marijuana a lesser of evils. It helped with restless legs, nausea, pain, and anxiety.”

Marijuana may now be a viable option for those who wish to try it, because it’s now legal for medical use in 29 states and for recreational use in nine states plus Washington DC. Unlike opioids, marijuana provides pain relief with a lower risk of addiction and nearly no risk of overdose. Plus, comprehensive studies like this one from the American Pain Society found that medical cannabis use is associated with a 64 percent decrease in opiate medication use.

While studies have supported the use of marijuana to reduce opioid use, further research needs to be done as reported in the The Daily Beast. Dr. Junig also advises that patients should not start new mood-altering, addictive substances in order to taper off Suboxone.

CBD Oil

Three of the Suboxone patients polled were able to taper with the help of cannabidiol, also known as CBD oil. Experts emphasize the distinction between marijuana and CBD oil: CBD oil is not psychoactive, meaning that it doesn’t make patients feel “high” like the THC in marijuana. CBD oil may be a more viable option for people in states where marijuana has not been legalized and also for those who do not want mood altering affects, but strictly relief from physical symptoms. "I used CBD oil during the taper because pot isn't legal in my state and it helped with restless legs, sleep, and anxiety," Pablo said.

A 2015 study in Neurotherapeutics examined the therapeutic benefits of cannabidiol as a treatment for opioid addiction. They found that CBD oil is effective in reducing the addictive properties of opioids, mitigating withdrawals, and lessening heroin-related cravings. Specifically, it relieved physical symptoms such as: nausea, vomiting, diarrhea, runny nose, sweating, cramping, muscle spasm. Additionally, it treats mental symptoms like anxiety, agitation, insomnia, and restlessness. The study states CBD oil is effective with minimal side effects and toxicity.

Kratom

In our survey, the people who tried kratom claim that the herb is a controversial yet effective way for tapering from Suboxone. Some experts agree. According to the Mayo Clinic: “In Asia, people have used kratom in small amounts to reduce fatigue or treat opium addiction. In other parts of the world, people take kratom to ease withdrawal, feel more energetic, relieve pain, or reduce anxiety or depression.”

Four of the individuals surveyed used kratom for tapering off Suboxone. Christine said, “I was very tired when coming off Suboxone, so kratom helped give me the energy to work, clean my house, and take care of my kids.”

Cristopher R. McCurdy, PhD, a professor of medicinal chemistry at University of Florida’s College of Pharmacy in Gainesville, studies kratom. McCurdy told WebMD: “I definitely believe there is legitimacy to using kratom to self-treat an opiate addiction.”

Despite these positive reviews, the Mayo Clinic and Web MD caution that kratom can also lead to addiction and withdrawal. According to an article on WebMD, “There’s little research on the herb’s effects on people, and some experts say it also can be addictive. The herb is illegal in six states and the District of Columbia, and the Drug Enforcement Administration is considering labeling it as a Schedule I drug…For now, the agency calls it a ‘drug of concern.’”

Pharmaceutical Remedies

Five of the people surveyed said that they tapered with the support of medications prescribed by their doctors to treat individual withdrawal symptoms. It is best that patients talk with their doctors and addiction professionals to see if a particular medication is right for their situation.

Happy tapering! I plan on writing more in the future about my experience and progress tapering off Suboxone. If you’re embarking on this journey, I wish you luck!

The names of some individuals have been changed to respect their privacy.



Have you successfully tapered off Suboxone or methadone? Or are you a “lifer” like Shannon? We’d love to hear your thoughts, experiences, and tips in the comment section.