How Long Should You Take Buprenorphine?
Professional societies agree: There is no scientifically established expiration date.
Much is said about buprenorphine. Far less is said about how long treatment should last. The professionally accepted standard has four elements.
- Take Buprenorphine if you benefit from it.
- Discontinue buprenorphine if you are no longer receiving benefit from it or develop a rare side effect. A wise patient will discuss this decision with your physician before deciding to stop on your own. Stopping is very serious.
- Buprenorphine treatment is governed by federal regulation and state rules. You must be willing to follow the rules required for treatment.
Everyone has an opinion about how long you should take buprenorphine. Your spouse, your parents, your minister, and your friends will all have an opinion. On YouTube, I found numerous reviews of Suboxone. You will not lack opinions.
Some patients take buprenorphine briefly: Others for months to years: Some continue indefinitely. In the end, this is your choice.
Your Life! Your Choice!
By William Conway, MD, FACP, FASAM
Internal Medicine, Metabolic Health and Diabetes, Longevity
Nashville, Tennessee, October 2026
Opioid Use Often Has a Long Career: Opioid Use Can Last for Years to Decades
Opioids may have become part of your life early. Opioid Use often has a long and uneven course stretching over years to decades. The path is rarely straight. People begin opioids, escalate their use, enter treatment, stabilize, stop, return to opioid use again, and enter treatment again months or years later.
Times change. You may have begun with OxyContin, moved to heroin, and progressed to fentanyl as heroin became harder to get. Your life, work, and family all change. You may adapt your opioid use to your new circumstances; The path is rarely straight. The path has its twists and turns.
So What? Before asking how long the treatment of buprenorphine lasts, perhaps you should ask long your career in opioids will last? If your opioid use continues over the years to decades, should your treatment last years to decades?
There Are Four Paths with Buprenorphine
You have a life with opioids. If you choose buprenorphine, think about buprenorphine as a crossing from one part of life to another. Your crossings differ in length. Some patients have many different crossings in life.
There are four crossings with buprenorphine.
- A brief crossing: Buprenorphine is taken briefly and then stopped.
- A longer crossing: Treatment continues for months to years before stopping.
- Crossing back and forth: Treatment begins, then stops, and later restarts, with the pattern repeated more than once.
- A Lasting crossing: Buprenorphine remains part of life for many years, sometimes for life.
The future is not known at the beginning. A person who hopes to stop in six months may find that longer treatment makes more sense. Someone who stops may encounter the unexpected and return to treatment. A person may be ambivalent, starting and stopping repeatedly over the years.
What Happens When You Stop Taking Buprenorphine?
This may be the least understood part of stopping buprenorphine. Everyone assumes that after stopping buprenorphine, everything will remain the same. Everything remaining the same is the exception, not the rule. During treatment, your body has adapted to a new reality with buprenorphine. You feel normal again. You no longer crave opioids. You probably have more money in your pocket.
Because you feel normal, you may believe you have been cured. After all, you may think your opioid use was just like the “flu.” It has passed. Then, your new biological reality begins. Withdrawal will occur. Cravings may begin. Your opioid -induced insomnia may return. The chronic pain from your old football knee may become bothersome again.
Your last dose of buprenorphine is graduation into a new stage of life. Your family may congratulate you for stopping buprenorphine, in their false belief that “buprenorphine is trading one addiction for another.” They are wrong. Buprenorphine is a treatment, not a disease. The suffering you experience discontinuing buprenorphine is an expression of a treatment adverse effect that predictably occurs with discontinuance.
My patients have told me that stopping buprenorphine was harder on them than stopping heroin.
Looking into my crystal ball, when I am asked what the weather will be like in Nashville tomorrow, or how you will fare off your treatment, I do not have the answer. Using the slang employed in internal medicine rounds, I am “clueless “ about what will happen when you stop buprenorphine. I can quote you in painful detail the medical literature. The medical literature does not tell you what you want to know:
“ How will I do off buprenorphine?”
In the dry language of medicine: A favorable clinical profile is not a validated prediction rule.
The Real Question is How You Want to Live
The duration of your buprenorphine treatment matters only in terms of the real question:
“ How do you want to live?”
People’s answers to how they want to live change as they move through life. Is your life about work, family, health?
Medications, from insulin to antibiotics to Prozac to buprenorphine, are treatments. They are not your life. They are tools to treat diseases and improve health.
Ask the following:
- Review the past. What was life like before and after buprenorphine?
- Look to the present. What are benefits you receive from buprenorphine beyond recovery?
- Look forward. What is your confidence in maintaining recovery without buprenorphine?
- Do you think taking buprenorphine is a moral failure?
- Do you think stopping buprenorphine is a moral victory?
Your goal is your life. Your goal should not be to get off medication at any unexamined cost.
Two Stories About Long-Term Treatment
Why do stories belong in the series? Science tells us what happens to groups. Stories show us individual choice, circumstance, history, and blind luck.
Understand the difference between science and literature. Science and stories have two different jobs.
The Conways
I know Conways well. I will describe my mother and adopted sister. Both are dead. My sister’s first name and married name are fictionalized for obvious reasons. My sister’s life story is true.
My mother, Nell Elizabeth Conway, was born in Blytheville, Arkansas, in 1915 to a Kentucky family. You will follow her family as floods and economic hardship push them north. You will follow her through college in Michigan in the Great Depression, teaching in Dearborn, Michigan, during World War 2. After marrying a professor who served in the OSS during World War II, her postwar life settled in an Ohio college town. Her diabetes was compulsively treated. She lived to eighty-six through periods of both hardship and prosperity. She became the matriarch who supported extended kin. Her story raises the question: What is successful treatment?
Sally Conway O’Connor was my adopted sister. Sally moved from Ohio to Boston. She married into an Irish Catholic family. Her severe depression responded to treatment at Mass General. After she chose to discontinue treatment for depression, she fell into a deep, permanent sadness that did not respond to the subsequent treatments available at that time. Her story raises the question: What does successful treatment mean when it is stopped?
The Imaginary Women of Sukti County, West Tennessee
This fictional multigenerational family follows the arc of life, from adolescence to old age, across generations of Imaginary Women, from the Civil War to contemporary times. Enjoy a trip into Tennessee history as you explore the diseases, psychodynamics, failures, and successes of this fictional West Tennessee family.
This fictionalized story grew from watching life in my small town in West Tennessee, studying Tennessee’s history, and reading deeply. West Tennessee is wonderful.
I love Tennessee. I wish to share my love with you.
Conclusions:
Deciding how long to take Buprenorphine should be straightforward. In fact, your decision can be complicated. To unravel the complexity of this decision, I have prepared the following blog series:
- Introduction
- Six Months to One Year
- Three to Five Years
- What Happens When Buprenorphine is Stopped
- Tapering Buprenorphine
- Can Some Patients Successfully Stop?
- Long-Term Use of Buprenorphine
