Pain Management Specialist in San Diego & La Jolla

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Method for tapering off the last 2 mg tablet of Subutex

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This step is very difficult.

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It has been a puzzle for physicians.

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Subutex is much stronger than most doctors understand. The FDA does not publish how strong it is compared to morphine because it is approved in the US only for opioid addiction, and potency is important only for pain control. But many pain specialists find subutex may control  pain far better than other opioid analgesics without the same side effects. Europe has approved Subutex for both pain and addiction.

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One milligram of Subutex is equal to 30 to 50 mg of morphine which means 2 mg Subutex equals 100 mg morphine. If it is important to take someone off all opioids, it is best to slowly taper off. Before proceeding to the use of Butrans patches, check the EKG. Prolongation of the QTc interval is listed as a warning for the patch, but curiously not for the much stronger tablet or film of the same buprenorphine.

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How to Taper

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1. Begin 3 Butrans patches and stop the daily 2 mg Subutex tablet (or 2 mg Subutex film).

Each Butrans patch delivers 0.5 milligram of buprenorphine, thus 3 Butrans patches = 1.5 mg/day. The patches last one week.

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2. Decide if you wish to reduce the dose every week or perhaps drop the dose every second or third week or six weeks, whatever you choose.

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3. When you drop the dose again, then apply only two Butrans patches every week before next change.

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4. Then one Butrans patch every week.

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Then stop all Butrans when ready.

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If the patient is using Butrans for control of substance abuse, that decision will need to be between their addictionologist and their psychologist or psychiatrist. Emotional stability and understanding of triggers for addiction must come first before making the important decision or relapse may occur.