Mental Health  |  OST Drug Issues Pathway - Method of Withdrawal




Mental Health

OST Drug Issues Pathway - Method of Withdrawal

There is no ideal method of withdrawal from methadone or suboxone. There are three possible approaches to withdrawal:

1. Fixed
The rate of reduction of methadone or suboxone is set by the GP in consultation with the patient and can only be altered by the GP. Recommended methadone reduction rate is 2.5mgs per script cycle. Some patients tolerate larger and faster initial reductions. Statistically the faster the reductions, the higher the rate of relapse as smaller reductions are better tolerated and momentum maintained.

2. Flexible
The rate of reduction of methadone or suboxone is set within a dose range by the GP (e.g. up to 5mg per week) and the patient may initiate reductions within this range. These patient initiated dose changes may only be   reductions, any increase in dose must be renegotiated with the GP and a new prescription written.

3. Blind
The patient has the option of requesting a blind reduction, to be arranged by the GP in consultation with the GP Liaison Nurse and Pharmacist and the script to be appropriately annotated by the GP. The details of the dose reductions and administration are arranged by the GP with the pharmacist.

Decisions must be made after assessment of the patient's needs and preferences, and in consultation with the patient.

Rate of withdrawal:

The following guidelines are recommended:

Current methadone or suboxone dose/day

Weekly or fortnightly or monthly reduction

Above 50mg

5mg or less

30-50mg

2.5mg or less

Less than 30mg

1-2mg or less


The rate of withdrawal should be reviewed each time a patient is seen. If there is evidence that a patient's treatment outcomes are compromised by the rate of withdrawal, a slowing or cessation of the dose reduction, or even a temporary increase in the dose is recommended, rather than introducing ancillary medication.

Note:  Once down to 30mg per day or less, consider changing to the Biodone 2mg/ml substance to enable small reductions to be made more easily. The pharmacy will need to be notified in advance so that they can order this in.

Consider transfer to suboxone from lower methadone doses, as dose reductions of suboxone are generally better tolerated.

*See Section 3.9.1 Planned Withdrawal page 29 of  " New Zealand Practice Guidelines for Opioid Substitution Treatment 2014"



Last updated : Wednesday, November 11, 2015
Next review date : Thursday, November 10,2016


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