Is son’s slow withdrawal from opioid treatment too slow? Or normal?

DEAR DR. ROACH: Can you tell me the best way for a person to withdraw from Suboxone and how long it usually takes? My son was an opioid addict and has been on Suboxone films for four years for his recovery. He is now very gradually weaning off of it by reducing the amount he takes each week. This has been going on for months. His physician is overseeing it, and together they determine the percentage he is to reduce it by. I have since heard that this is a brutally painstaking way to do it — not that all of this hasn’t been brutal — and that he would be better off going to a hospital and going through the withdrawal there, in a much shorter time period. Also, I’ve read that four years is a terribly long time to be on Suboxone and he never should have been on it for that long. Can you help to clarify?

— Anon.

ANSWER: Suboxone is a combination of two medications that partially block the effect of opioids. It is an effective treatment for opioid withdrawal symptoms. However, it is not, by itself, a treatment for opioid dependency, and should be used as part of a comprehensive treatment. This is done by an expert in addiction medicine.

Suboxone can be used for short periods of time, say four to 12 weeks. I have seen patients on it for as long as a year, and have read that it may be used for longer, but four years is beyond my experience. However, that does not mean it may not be appropriate. Stopping opioids suddenly leads to withdrawal symptoms, while slow tapering generally prevents these bad symptoms. Too-rapid withdrawal may make relapse more likely.

I am relieved to hear that the doctor is slowly reducing the amount, as most experts feel the goal is to be off of all opioids. As with methadone, some experts use Suboxone long term to prevent relapse. I can’t say whether this treatment has been ideal for your son, but it does sound like there is a plan and he continues to progress.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.