The Myth of Tapering

The Myth of Tapering

It is unclear where the erroneous recommendation to taper during Medication Assisted Treatment (MAT) began, since no reputable authority on substance abuse treatment recommends tapering.  On the contrary, every professional organization involved in the field of addiction recommends long term treatment, not tapering.  The two primary textbooks on the issue,  Principles of Addiction Medicine, published by the American Society of Addiction Medicine (ASAM), and The Textbook of Substance Abuse Treatment, published by the American Psychiatric Association, both clearly state that maintenance is the standard of care.

“The American Society of Addiction Medicine supports the principle that maintenance is most effective as a long term modality.”  “Treatment should be continued as long as the patient continues to benefit from treatment…”  “Maintenance continues until such a time that there is a reason to alter the treatment.”  Principles of Addiction Medicine, 4th edition.

“There is no time requirement or restriction to the length of time patients can receive buprenorphine maintenance treatment.  In general, relapse to illicit opioid use and treatment dropout is high during opioid detoxification (tapering), such that opioid addiction is considered a chronic, relapsing disorder deserving ongoing treatment and monitoring much like other chronic medical diseases (e.g., diabetes mellitus).  Textbook of Substance Abuse Treatment.

Also, in a recent statement by the current president of ASAM, he again reiterated that MAT is treatment for a chronic disease, and tapering is to be avoided.

Perhaps this myth has its origins in the federal government’s attempts over 40 years ago to taper people off of methadone.   “In the early 1970’s, efforts to limit the duration of treatment and to cap the dose occurred initially at the federal level and later were initiated by some individual state methadone authorities.”  Since that time numerous studies have uniformly validated the importance of continuing treatment indefinitely, and have clearly shown that tapering results in relapse.  “The known risks of discontinuing treatment, with predictable relapse… suggest that long-term –even indefinite—treatment is appropriate and even essential for a significant proportion of eligible patients.” Principles of Addiction Medicine.

Hopefully this discussion has clarified some common misconceptions surrounding the treatment of addiction with medications, especially buprenorphine.  We have information available on our web site,  highpointclinic.org, and ongoing educational lectures on addiction provided by physicians Board Certified in Addiction Medicine.  For additional information, or a schedule of educational events, please contact us at Evidence Based Addiction Medicine at 423-631-0731.

Vance Shaw, M.D.,   Board Certified by the American Board of Addiction Medicine

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