Discontinuing extended-release buprenorphine: Participant experiences from a mixed-methods observational study.

BACKGROUND: Although clinical guidelines support long-term buprenorphine treatment for opioid use disorder (OUD), evidence guiding planned discontinuation is limited. Extended-release buprenorphine (BUP-XR) produces a slow decline in plasma concentrations that may function as a natural taper. This study examined clinical and qualitative outcomes following planned BUP-XR discontinuation. METHODS: This observational study followed participants for 6 months after BUP-XR discontinuation and included qualitative interviews exploring perspectives on discontinuation. Eligibility: adults with ≥ 12 months BUP-XR treatment, controlled OUD and other substances, and joint provider-participant agreement on treatment discontinuation. Primary endpoint: successful treatment discontinuation at 6 months, defined as no consistent self-reported nonmedical opioid use (≥1 day/week for 4 consecutive weeks or 7 consecutive days) and not restarting long-term OUD treatment due to withdrawal symptoms or nonmedical opioid use. RESULTS: Twelve participants enrolled; one excluded for ineligibility. Eleven completed 6-month follow-up; 10/11(90.1%) met successful discontinuation criteria. Withdrawal symptoms were generally mild, nonpersistent, and resolved by Month 6. Opioid craving remained low throughout. No deaths, pregnancies, overdoses, or withdrawal-related adverse events occurred. One participant experienced non-study-related adverse events: pneumonia/empyema with hospitalization and macrocytic anemia. At interviews (on average 12 months post-discontinuation), all participants remained off treatment without persistent opioid use; one reported a brief, time-limited return to opioid use. Participants described minimal opioid withdrawal, low craving, and stable functioning across domains. CONCLUSION: After long-term BUP-XR treatment, discontinuation was effective and well tolerated over 6 months. BUP-XR's pharmacokinetic profile may safely support a gradual taper when paired with patient-centered care, psychosocial support, and ongoing engagement.