Buprenorphine Withdrawal: Understanding Symptoms, Duration, and How To Stay Safe

What is Buprenorphine?

Buprenorphine is a partial opioid agonist that only partially activates opioid receptors in the central nervous system (CNS), making it an effective tool for medication-assisted treatment (MAT) for those with opioid use disorder. [1] Its effect of blocking other opioids like heroin and oxycodone at the receptor site has helped many people stabilize their lives during recovery.

Although buprenorphine is an excellent tool for treating opioid addiction, buprenorphine itself is an opioid. Stopping or substantially reducing dosage abruptly can bring on withdrawal symptoms. Understanding what to expect during this process can help you feel more prepared.

Common Buprenorphine Withdrawal Symptoms

Withdrawal symptoms from buprenorphine can vary widely from person to person. They can range from mild to extreme and are dependent on the dose and duration of use.
Common physical symptoms include:

• Nausea
• Vomiting
• Diarrhea and stomach cramping
• Headache
• Fatigue and drowsiness
• Fever
• Muscle aches
• Chills
• Runny nose and sneezing
• Sweating

In addition to physical symptoms, there are also significant psychological symptoms associated with buprenorphine withdrawal. [2]

Common psychological symptoms include:

• Anxiety
• Depression
• Mood swings
• Cravings
• Difficulty concentrating
• Loss of motivation
• Anhedonia (inability to experience pleasure)
• Memory loss and confusion

Some people also experience post acute withdrawal syndrome (PAWS), which was originally documented in patients with alcohol addiction. [3] PAWS includes prolonged symptoms of low mood, disturbed sleep patterns, and cravings for opioids. Support systems are important for helping individuals cope with PAWs.

How Long Does Buprenorphine Withdrawal Last?

Due to buprenorphine’s long half-life (the amount of time necessary for the concentration of a drug in the blood to decrease by half), withdrawal from buprenorphine tends to be less intense than withdrawal from shorter-acting opioids such as heroin or oxycodone. [4]

However, because of its long half-life, buprenorphine withdrawal can last longer than withdrawal from shorter-acting opioids. For example, while opioid withdrawal symptoms from substances like heroin or oxycodone typically resolve within five to ten days after the last dose, withdrawal symptoms from buprenorphine can linger for weeks.

Withdrawal from lower doses of buprenorphine (less than 4mg per day) typically begins within four to six hours of the last dose, while withdrawal from buprenorphine at higher doses (greater than 8mg per day) typically does not begin until 24 to 36 hours after the last dose. [5]

Tapering Off Buprenorphine Safely

To minimize discomfort and prevent relapse, tapering from buprenorphine should be done slowly and under the close supervision of a qualified healthcare professional. [6]  The recommended method of tapering from buprenorphine is to reduce the dose by 10 to 25% every one to two weeks. The closer the patient is to discontinuing the medication, the slower the taper should proceed.

Therefore, tapering may progress as follows: starting at 16mg per day, the patient is tapered down to 12mg, then 8mg, followed by 4mg, 2mg, and finally 1mg per day, at each level for one to two weeks. After reaching 1mg per day, additional tapering can proceed at intervals of several days between doses.

If at any point during the buprenorphine detox process the patient experiences excessive discomfort or desires to resume their previous dose, the taper may be adjusted. The ultimate goal of tapering is a safe and successful discontinuation of the drug.

Managing Symptoms During the Taper

Nutrition and Exercise

To alleviate discomfort caused by withdrawal during the tapering process, hydration and good nutrition are beneficial. Moderate exercise and stretching can also provide relief. Techniques such as meditation and mindfulness, the practice of intentionally focusing on the present moment with non-judgmental awareness of your thoughts, feelings, bodily sensations, and surroundings, may also prove beneficial by promoting relaxation and distraction. [7]

Medication-Assisted Therapy

There are various over-the-counter products that can assist with alleviating particular withdrawal symptoms, such as anti-nausea or anti-diarrheal agents. Additionally, clonidine may be prescribed for withdrawal symptom relief. However, any new product or medication should always be approved by a doctor before use.

Mental Health Support

Psychological support and counseling can also assist recovery during this transitional phase. Cognitive behavioral therapy, dialectical behavior therapy, and participation in peer support groups offer numerous benefits during this time. Mental health services should remain accessible throughout this process to help treat depression, anxiety, and cravings that may follow withdrawal. [8]

When To Seek Professional Assistance

Although buprenorphine withdrawal is generally considered a manageable process with medical supervision and complications rarely arise, there are instances when immediate medical intervention is warranted.
Emergency or urgent care should be sought for:

• Severe vomiting causing dehydration
• Uncontrollable cravings for drugs
• Thoughts of suicide
• A dangerous elevation in temperature or heart rate

At Alpas, we recognize that tapering off buprenorphine can be a highly personal decision that may be difficult for many individuals to consider. We want you to know that our multidisciplinary team offers compassionately guided, evidence-based treatment programs and personalized treatment plans for adult individuals withdrawing from buprenorphine. Whatever level of care you may require, we are committed to supporting you through this critical juncture of your journey in sustained recovery.