Related Experiment Video
Updated: Nov 25, 2025

Less-Invasive Technique for Non-stabilized Mandibular Fracture in Mouse Models
Published on: September 27, 2024
Discontinuing Methadone and Buprenorphine: A Review and Clinical Challenges
Joan E Zweben1, James L Sorensen, Mallory Shingle
1San Francisco VA Medical Center, University of California, San Francisco, CA (JEZ), Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA (JLS), Department of Psychiatry and Behavioral Sciences, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA (MS), Oregon Health and Science University, Portland VA Hospital, Portland, OR (CKB).
Abstract:
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.
Related Concept Videos
Opioid Analgesics: Synthetic and Semisynthetic Opioids
Analgesia and Pain Management
Drug Dependence
Drug Abuse and Addiction: Pharmacological Phenomena
Phase II Reactions: Methylation Reactions
The mechanism of methylation unfolds in two stages. The first stage sees a methyltransferase enzyme facilitating the transfer of a methyl group from S-adenosylmethionine (SAM) to the substrate, forming S-adenosylhomocysteine (SAH). The second stage involves further metabolism of SAH into homocysteine, which can be recycled...
Therapeutic Drug Monitoring: Affecting Factors

