Author: Alex Thompson
Precipitated Withdrawal: Definition, Symptoms, Traits, Causes
Every year, thousands of people successfully overcome opioid addiction and begin a meaningful life of sobriety. Long-term counseling is also critical, even after many years of sobriety. Counselors can help patients identify warning signs they may have missed, provide additional training and guidance, and help treat mental health conditions that may be underlying causes of addiction. There are thousands of opioid treatment programs throughout the country. Medically supervised detox programs help patients get through withdrawal safely and comfortably. Both inpatient and outpatient rehab programs help patients uncover the underlying causes of their addictions and identify their triggers and healthy coping mechanisms.
As a result, it doesn’t trigger the same sort of euphoric sensations as other opioids — but it will suppress withdrawal symptoms and stop cravings. 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.
- 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.
- However, the defining feature of precipitated withdrawal is the rapid onset of withdrawal symptoms.
- The symptoms of precipitated withdrawal vary depending on the opioid.
- The pharmacist can then check for drug interactions and advise you on the best way to take your medications to avoid precipitated withdrawal.
Onset is generally around 4–6 hours after the last use of opioids. A 2010 study suggests that precipitated withdrawal occurs in around 9% of people who take buprenorphine to manage OUD. For example, medications like Ondansetron help manage nausea and vomiting. Staying hydrated is also important during precipitated withdrawal to prevent complications. Naloxone is not what causes the withdrawals when Suboxone is taken orally.
To prescribe this medication, however, professionals need to have completed an “x-waiver,” so this isn’t always a convenient option. Others might be hesitant to prescribe it for a variety of reasons, including stigma around opioid use disorder. Opioid antagonists, which include naloxone and naltrexone, work in the opposite direction.
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While spontaneous withdrawal — withdrawal that occurs when you stop using a substance — tends to be a gradual process, precipitated withdrawal happens quickly. The doctor helping you will assess your opioid use history, including which opioids you used and how much time has passed since your last use. They’ll also record your overall health, medical history, and pre-existing health conditions. Individuals should observe a specific opioid-free interval before starting Suboxone or naltrexone. Precipitated withdrawal is a rapid-onset withdrawal syndrome that typically develops within 1–2 hours when a person takes these medications before opioids have left their system. A person can speak with a healthcare professional for support if symptoms become unbearable.
Every year, over 100,000 people die from drug overdose in the U.S., the vast majority of which were fully or partially caused by opioids. Typical treatments include intravenous fluids, sedatives, anti-nausea medications and other medications. Extremely agitated patients may require heavy sedation or general anesthesia. If you develop precipitated withdrawal after your first dose of Suboxone, your doctor may administer additional doses of the drug. If these drugs are taken too early during the detox process, they can bring on sudden and severe withdrawal symptoms.
Precipitated withdrawal refers to withdrawal that’s caused by a medication, rather than abstinence. Generally, it’s best to start with lower doses of the medication and then increase, if necessary, after observing the reaction to the lower dose. With Suboxone, symptoms develop within one to two hours of the first dose and usually resolve within a few hours but can last as upwards of one day. 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. According to the Food and Drug Administration (FDA), naloxone cannot cause harm to a person who does not have opioids in their system.
If they aren’t, the drug will knock any remaining opioids off the brain’s receptors and plunge the person into an immediate and agonizing withdrawal. Using more buprenorphine when experiencing symptoms of precipitated withdrawal can stop the symptoms. However, this is counterintuitive as precipitated withdrawal is brought on by the buprenorphine in the first place.
Drugs That Can Cause Precipitated Withdrawal
Increasing buprenorphine should not lead to overdose because it is only a partial agonist. This means it should ease symptoms without triggering the full effect of an opioid. For example, spontaneous withdrawal due to heroin, oxycodone, or hydrocodone typically lasts around 5 days.
Therefore, acute withdrawal symptoms may have a slower start before they fully kick in. The manner in which MAT medications are administered can help prevent precipitated withdrawal from occurring. This is why it’s important to use them with with the guidance of a healthcare professional. In people who are physically dependent on opioids, this sudden loss of signals from the opioid receptors triggers the symptoms of precipitated withdrawal. Precipitated withdrawal symptoms are rarely dangerous but it’s important to understand that complications can occur. These precipitated withdrawal symptoms can range from mildly uncomfortable to extremely distressing and painful, depending on how severe your dependence and opioid use disorder is.
According to a 2021 case study, healthcare professionals recognize withdrawal symptoms as part of precipitated withdrawal if symptoms start within 1–2 hours of receiving a partial agonist. No material on this site, whether from our doctors or the community, is a substitute for seeking personalized professional medical advice, diagnosis or treatment. Never disregard advice from a qualified healthcare professional or delay seeking advice because of something you read on this website. Preventing precipitated withdrawal is critical when helping patients transition from opioids to buprenorphine or other similar treatments. Luckily, there are ways to reduce the risk of precipitated withdrawal or minimize its severity if it does occur.
Recognizing an emergency
Starting with a smaller dose of buprenorphine may also reduce the risk. 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. I tried to go cold turkey from 4 mg a day, and I just had nothing but withdrawal for seven days and no relief.
If someone has trouble answering these questions, or their answers become less clear over time, it’s best to call for help. 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.
As an opioid antagonist, it also blocks mu-opioid receptors and can trigger a similar reaction. Anyone experiencing withdrawal symptoms can seek medical care for support. Precipitated withdrawal may occur when a person with an opioid dependence receives treatment that blocks or mutes opioids’ effects. The symptoms of precipitated withdrawal vary depending on the opioid. However, the defining feature of precipitated withdrawal is the rapid onset of withdrawal symptoms. The withdrawal symptoms that occur from some of these medications are known as precipitated withdrawal.