Tapering Strategies (2025-2026 Recording)-Tapering Strategies Recording

Video Transcription

Video Summary

The session focused on tapering strategies for addiction medications, especially methadone, buprenorphine, benzodiazepines, and briefly nicotine and barbiturates. Dr. Sarah Gonzalez and colleagues from Kern Medical outlined why tapering matters: abrupt discontinuation can be dangerous, increase relapse risk, worsen retention, and raise suicidality risk during withdrawal.<br /><br />They reviewed opioid pharmacology and emphasized the differences between methadone and buprenorphine. Methadone was described as a long-acting full opioid agonist with significant QT-prolongation risk, many drug interactions, and a need for slow outpatient tapering. Buprenorphine was presented as a partial agonist with high receptor affinity and a ceiling effect, making it safer in many cases and available in multiple formulations, including long-acting injectables. The talk highlighted that tapering buprenorphine becomes harder at lower doses, especially below 4 mg, due to receptor occupancy changes.<br /><br />For benzodiazepines, they reviewed dependence and withdrawal symptoms, including seizures and prolonged withdrawal. Guidelines discussed included the Ashton Manual, which uses slow substitution with diazepam, and ASAM recommendations for gradual dose reductions, often 5–10% every 2–4 weeks, with flexibility to pause or slow the taper. Adjunct medications such as clonidine, hydroxyzine, trazodone, gabapentin, and oxcarbazepine were discussed to manage withdrawal symptoms.<br /><br />Several case examples illustrated individualized tapering, shared decision-making, and the importance of adjusting plans based on adverse effects, patient preference, insurance barriers, and social instability. A patient guest speaker, Elmer, shared how addiction and withdrawal affected his life and emphasized the need for compassion, trust, and trauma-informed care.

Keywords

tapering strategies

addiction medications

methadone

buprenorphine

benzodiazepines

opioid pharmacology

withdrawal symptoms

relapse risk

ASAM guidelines

Ashton Manual

diazepam substitution

shared decision-making

trauma-informed care

withdrawal management