A Letter to My Patients: The Truth About Stopping Suboxone

​To My Patients:
​
Medication-Assisted Treatment (MAT) using Suboxone (buprenorphine/naloxone) is often the first step in reclaiming your life. It gives you a break from the chaos of opioid addiction, removes the physical cravings, and allows you to feel normal again. It gives you the stability to be the parent, the spouse, and the child you haven't been able to be for a long time.

While Suboxone is a miracle for stabilization, many patients eventually ask: "How do I get off this medication?"

Addiction is a chronic disease. No one wakes up one morning and decides to become an addict. It is a trap where you lose the trust of your family and the respect of yourself. Suboxone stops the bleeding, but it does not heal the wound. Once the drugs are gone, the real work begins. You must fill the void that caused the addiction in the first place through counseling, 12-step programs, and lifestyle changes.

The Philosophy of Weaning

I tell all my patients: Ideally, you should remain on Suboxone for 6 to 9 months—long enough to turn your life around, secure employment, and repair relationships. Once you are stable, we can discuss weaning (tapering).

I encourage weaning, but I do not require it. Many patients are afraid to stop. They fear the return of withdrawals, the fatigue, and the cravings. Some in the recovery community may tell you that taking Suboxone is "trading one addiction for another" or using a "crutch." I disagree. You are treating a medical condition. However, dependence on a medication is real, and stopping abruptly is not an option. Quitting "cold turkey" almost always results in weeks of extreme fatigue, insomnia, and relapse.

The only successful way to stop taking Suboxone is to wean very slowly over time. The goal is to decrease your dose so gradually that your body never realizes it is happening—even if your mind tries to trick you.

The "Micro-Taper" Method

Over my years of practice, I have developed a method that I have found to be the most successful for patients ready to taper.

1. The "Test" Phase If you were to stop Suboxone today, you likely wouldn't feel physical symptoms for 3 days, but your mind would panic within 12 hours. This is the mental obsession of addiction. To overcome this, I tell my patients to start small:

• Cut a tiny, almost invisible piece (approx. 0.13mg) off your strip or tablet.
• Throw it away.
• Take the rest of your dose as normal.

Do this for a month. Your body will not notice the missing 0.13mg, but your mind might obsess over it. Throwing it away breaks the mental attachment. Almost all my patients come back and say, "I can't believe how easy that was."

2. The Reduction Phase Once you realize you can survive on slightly less, we begin the true taper.

Decrease your dose by roughly 1/8th to 1/16th (0.25mg to 0.5mg) every week.

• Make your reduction on a Saturday. This gives you Sunday to see how you feel before the work week begins.
• Pre-cut your doses for the entire week on Sunday. If you don't prepare, life will get in the way, and you will likely slip back to your full dose.

3. Listen to Your Body If you drop a dose and feel unwell, go back to the last dose where you felt good. Wait a week, and try again. There is no shame in pausing. Do not taper during stressful times, such as holidays or family crises.

The Final Step: The "Jump"

As we continue, we will eventually reach a very low dose (0.25mg or 0.13mg). Once you are stable at this micro-dose for 3 to 4 weeks, we have two options to finish treatment:

Option A: The Naltrexone Protocol We transition you from the final micro-dose of Suboxone to 50mg of Naltrexone.

• What to expect: This effectively "washes out" the remaining opiates. You will likely experience one day of mild withdrawal and one day of fatigue. By the third day, most patients feel normal.
• Comfort Meds: I provide medications (such as Librium or sleep aids) to manage anxiety and insomnia during these 48 hours.
• This avoids the 3–4 weeks of "the blahs" and low energy that usually accompany stopping Suboxone. It creates a clean break.

Option B: Sublocade For those who can afford it (approx. $1,600–$1,800, rarely covered by insurance), Sublocade is a monthly injection of buprenorphine. It leaves the body so slowly that it essentially "auto-tapers" you. Most patients take 1–3 shots and never need treatment again, with virtually no withdrawal symptoms.

Moving Forward

Whether you stay on maintenance or choose to taper, the goal is freedom. If you are ready to start this process, we will do it at your pace, ensuring you remain safe, comfortable, and sober.

​I hope this helps.

Dr. Robert Westcott, MD, FASAM