Practical guidance for navigating buprenorphine discontinuation

Approximately 4.8 million people in the United States had opioid use disorder in 2024, with more than one hundred thousand experiencing an overdose death. Despite the established benefits of buprenorphine on morbidity and mortality, many patients may express an interest in discontinuing their medications for various reasons, including stigma surrounding addiction. There are limited studies describing how to navigate buprenorphine discontinuation. This commentary provides a practical approach to navigating buprenorphine discontinuation, using two case studies. Ideally, clinicians will develop a deep understanding of the patient's substance use journey, allowing them to understand both the internal and external factors driving their decision. Through this understanding, a clinician can develop a plan based on their well-being, safety, and risk factors for return to use. It is vital to reinforce that buprenorphine is a life-saving medication, can be continued life-long, and is a tool for recovery, not a barrier.