When (if ever) do you recommend taping a patient off of buprenorphine after sustained remission?

I rarely recommend tapering off buprenorphine after sustained remission for opioid use disorder (OUD) because typically, buprenorphine is well-tolerated, risks are minimal, tapering can be challenging, and the risk of overdose after tapering off MOUD is high.

Instances when I would consider a taper are 1) a patient is experiencing a side effect or adverse event that could be associated with buprenorphine, or 2) a patient requests to taper off. The approach for either situation would be similar. I have had patients with endocrinopathies (e.g., secondary infertility) who need to be tapered off buprenorphine to alleviate symptoms.

When a patient comes to me requesting to taper their buprenorphine, I usually start by asking why they want to do so...