Discontinuing Methadone and Buprenorphine: A Review and Clinical Challenges

Area of Science:

• Addiction Medicine
• Pharmacology
• Clinical Psychology

Background:

• Buprenorphine/naloxone is widely used for opioid addiction, with some patients and providers viewing it as a temporary solution.
• Many patients expect to discontinue buprenorphine/naloxone to achieve recovery, potentially misunderstanding its long-term benefits.

Purpose of the Study:

• To provide clinicians with recommendations for managing patient desires to discontinue opioid agonist treatment (OAT).
• To review the optimal duration of OAT, risks of discontinuation, and patient self-assessment tools.
• To promote shared decision-making between clinicians and patients regarding OAT cessation.

Main Methods:

• Literature review focusing on opioid agonist treatment, discontinuation risks, and recovery capital.
• Development of a patient self-assessment checklist for evaluating readiness to discontinue OAT.
• Framework for shared decision-making in OAT management.

Main Results:

• Evidence suggests most patients benefit from long-term OAT to maintain recovery gains.
• Discontinuing OAT carries significant risks that must be carefully considered.
• Recovery capital is a key concept in assessing patient readiness for OAT discontinuation.

Conclusions:

• Clinicians should guide patients through a thorough assessment before discontinuing buprenorphine/naloxone.
• Shared decision-making is crucial for determining appropriate OAT duration and managing discontinuation.
• Focusing on recovery capital can help patients and clinicians make informed choices about OAT cessation.