Author: Charles Frank

What is Precipitated Withdrawal? Drugs That Can Cause Precipitated Withdrawal

This helps ensure other opioids are no longer significantly occupying the brain’s opioid receptors. The symptoms and intensity of precipitated withdrawals are different for each person, based on factors like the type, amount and timing of opioids used, the individual’s metabolism and their level of opioid dependence. Precipitated withdrawal is an occasional response to opioid antagonists, such as naloxone or naltrexone, or partial agonists, such as buprenorphine, in people with opioid dependence.

We found that repeating doses of 8 mg, with close monitoring of changes in withdrawal symptoms and for sedation, allowed us to rapidly and safely relieve our patient’s symptoms. Within 24–48 h, symptoms settle and treatment continued in the community. More research is required to determine an evidence‐base for this rapid dose escalation in the setting of precipitated withdrawal, so prescribers can confidently treat this complication of buprenorphine treatment.

1. There is little documented experience regarding the management of precipitated withdrawal.
2. Generally, healthcare professionals can manage precipitated withdrawal by prescribing more buprenorphine or comfort medications.
3. The symptoms and intensity of precipitated withdrawals are different for each person, based on factors like the type, amount and timing of opioids used, the individual’s metabolism and their level of opioid dependence.
4. A person should be opioid-free for at least seven to 10 days before starting the drug.

The Clinical Opiate Withdrawal Scale (COWS) is a tool that can be used to guide the diagnosis of an established opioid withdrawal [7]. Once the patient is in opioid withdrawal, buprenorphine can be started with a decreased risk of precipitating a withdrawal [4]. Despite the use of clinical monitoring tools like the COWS, precipitated withdrawal can still occur, as demonstrated in our case.

Precipitated Withdrawals From Injecting Suboxone

In our case, a patient developed a significant precipitated opioid withdrawal following buprenorphine administration, and was able to be successfully treated in hospital with further buprenorphine. This demonstrates that rapid increases in buprenorphine dose can be used as an effective treatment for buprenorphine‐induced precipitated opioid withdrawal. The use of buprenorphine to manage withdrawal then allows the individual to continue on this highly effective treatment. This is a well‐recognised adverse outcome from buprenorphine induction [3, 4, 5], and was found to occur in 9% of buprenorphine inductions [6]. In this case, the patient gave a history of heroin use, a short‐acting opioid, prior to commencing buprenorphine treatment as an outpatient, and did not disclose to treatment providers his use of methadone. This is unusual to have the combination of raised COWS as well as recent long‐acting opioid use.

It’s gone from a little-used medicine only stocked in ambulances and hospitals to something found in most pharmacies and carried by laypeople in purses and backpacks.

The following morning 24 mg bup/nx combination was given and COWS monitoring ceased, as he reported he now felt comfortable on this dose, and there was no evidence of over‐sedation. He continued on 24 mg bup/nx combination and was able to be discharged on this dose. Several factors can determine the severity of these symptoms, including the duration of misuse, the opioid used, and a person’s physical and biological attributes. The clinical services offered through this website are provided by Bicycle Health Medical Group, PA and Bicycle Health Provider Group Inc., that are independent, physician-owned medical groups. For more information about the relationship between Bicycle Health, Inc. and the Bicycle Health Medical Group, PA and/or Bicycle Health Inc. and the Bicycle Health Provider Group Inc., click here.

Precipitated withdrawal symptoms may begin within one to two hours after the first dose of buprenorphine has been administered. When trying to recover from substance use disorder, the first step is to recognize your need to stop abusing the substance you’ve grown dependent on. During this process, medication-assisted treatment may be used to help you cope with withdrawal symptoms and block the urges to use the illicit substance. Following the additional 8 mg bup/nx combination his COWS reduced to 22 at 1135 h and 5 at 1327 h.

How to Prevent or Treat Precipitated Withdrawal Symptoms

To lower your risk of precipitated withdrawal, take your opioid replacement therapy only as directed. Be honest with your treatment team about the last time you used opioids. If you develop any of the signs or symptoms mentioned above, seek immediate medical attention and contact your doctor. If you are experiencing particularly severe precipitated withdrawal symptoms, you might want to give your doctor or provider a call.

Taking more opioids does not help like with normal opioid withdrawal and overdose is much more likely. Precipitated withdrawals are usually described as an intense and distressing experience that is similar to, but worse than regular opioid withdrawal. With normal use, the naloxone generally doesn’t get absorbed in the bloodstream. But, if Suboxone is injected, the Naloxone is activated and can cause precipitated withdrawals.

What Precipitated Withdrawal Is Like

Understanding how medically-assisted treatment with buprenorphine works is crucial to grasp how precipitated withdrawal can occur. Precipitated withdrawal is a rapid and intense onset of substance use withdrawal symptoms. Precipitated withdrawal can occur during a detox program using medication-assisted treatment (MAT) instead of allowing the substance to naturally leave the body. Some of the medications addiction specialists use during detox are naltrexone and suboxone (which is made with buprenorphine). Naltrexone requires a longer drug-free window to reduce the risk of precipitated withdrawal. A person should be opioid-free for at least seven to 10 days before starting the drug.

Based on your current situation, your doctor will be able to advise you on the safest antagonist to take and when you should start taking it. Opioid withdrawal symptoms often start when someone stops taking an opioid cold turkey. However, in some cases, withdrawal can start even when you keep taking the opioid. This occurrence is called precipitated withdrawal and can be caused by taking medications that interact with opioids. If you take opioids, it is important to know how to avoid precipitated withdrawal.

Plus, once you take the buprenorphine for precipitated withdrawal, you will already be set up to take buprenorphine long-term for MAT, if that’s the course that you would like to take. Otherwise, if you are experiencing symptoms, you can use OTC pain relievers, Pepto Bismol, and Immodium, as well as engage in self-care practices like hydrating, resting, taking vitamin supplements, and eating nutritious foods. Taking more Suboxone also makes symptoms worse because more opioids get knocked off the receptors. For naltrexone, it is generally best to wait 7–10 days after the last opioid dose before taking it. If precipitated withdrawal has started, there are a few steps a person can take to improve comfort. This article explains why precipitated withdrawal happens and how doctors manage it.

In January 2022, the Food and Drug Administration (FDA) issued a warning related to dental problems caused by buprenorphine when administered by dissolving in the mouth. This warning follows reports of dental problems including tooth decay, cavities, oral infections, and loss of teeth. This serious adverse effect can occur whether or not you’ve had a history of dental problems.

The key difference between them is that the former comes on suddenly, brought on by the use of MAT medications. On the other hand, the latter occurs gradually when a person stops using substances they’ve grown dependent on. The symptoms of precipitated withdrawal are more severe than spontaneous opioid withdrawal. Normally, opioid withdrawal happens gradually over the course of a few days or weeks as the body rids itself of the drugs and readjusts. But drugs such as buprenorphine and naltrexone can speed and worsen the process if they’re not used correctly.

You should wait at least 12 to 24 hours after your last use of a short-acting opioid, such as oxycodone or heroin, before starting Suboxone. If you’re using a long-acting opioid, such as Oxycontin or methadone, you should wait at least one to two days. Suboxone is often prescribed for opioid addicts to help remove the substance from the person’s body prior to substance abuse rehab. Suboxone is a combination of buprenorphine and naloxone and together, these substances are a powerful tool to help reduce an addict’s compulsive behaviors and keep cravings to a minimum.