Opioid addiction is a common issue in the United States, affecting millions of Americans each year. According to the National Institute of Drug Abuse, 80,411 people died from an opioid overdose in 2021.[1] Because opioid use disorder often leads to life-threatening overdoses, addiction treatment programs have begun using more aggressive approaches to treating the condition.
One of the most effective treatments for opioid addiction is medication-assisted treatment (MAT). This treatment method involves the use of medications to limit withdrawal symptoms and prevent cravings while clients engage in behavioral therapy and counseling sessions.
However, some of the medications used during MAT can cause a condition called precipitated withdrawal if they are taken too early or abused. Precipitated withdrawal is considered a medical emergency, so to avoid it, you should always take your medications exactly as prescribed.
What is Precipitated Withdrawal?
During medication-assisted treatment (MAT), medications like buprenorphine, methadone, and naltrexone are used to help make early recovery easier for individuals overcoming opioid addiction. Methadone is an opioid. Buprenorphine is a partial opioid agonist that activates the opioid receptors in your brain to prevent withdrawal symptoms. Naltrexone is an opioid antagonist that blocks opioid receptors to prevent cravings and the effects of other opioids.
Precipitated withdrawal is characterized by severe withdrawal symptoms that occur if you take products containing buprenorphine too early. If you have not detoxed off of opioids before you take buprenorphine, you may go into immediate and severe withdrawal.[2] While opioid withdrawal is generally not life-threatening, precipitated withdrawal can cause your symptoms to become increasingly difficult to cope with.
It’s vital that you are under the direct supervision of a medical doctor when you are taking MAT medications. They will make sure your body has eliminated opioids from the system before starting MAT.
What Causes Precipitated Withdrawal?
Buprenorphine binds to your opioid receptors in a similar manner as opioid drugs of abuse like heroin or oxycodone. However, buprenorphine only partially activates your opioid receptors, ensuring that you do not experience an addictive high.
Buprenorphine has an extremely high binding affinity. This means if opioids are still in the system when you take buprenorphine, buprenorphine will knock opioids off of your opioid receptors, fully displacing opioid molecules suddenly.
Normally, when you detox from opioids, opioid molecules leave opioid receptors gradually, resulting in a slow onset of withdrawal symptoms. But when opioid molecules are displaced suddenly and replaced with buprenorphine, withdrawal symptoms will begin all at once, becoming extremely uncomfortable and sometimes life-threatening.
As a result, you should wait at least 12-24 hours after taking an opioid to start buprenorphine medications including Suboxone. Waiting until you are experiencing withdrawal symptoms can prevent precipitated withdrawal.
What are the Symptoms of Precipitated Withdrawal?
Symptoms of precipitated withdrawal can begin anywhere from a few minutes to a couple of hours after your first dose. Typically, the symptoms come on intensely and quickly, lasting for up to a day.
The symptoms of precipitated withdrawal can make you feel incredibly sick. Typically, these symptoms are way more severe than regular opioid withdrawal symptoms, so it is important to seek medical treatment.
Symptoms of precipitated withdrawal include:[3]
- Abdominal pain
- Nausea and vomiting
- Diarrhea
- Severe muscle aches and pain
- Confusion
- Fever
- Low blood pressure
- Elevated heart rate
- Headaches
- Irritability and anxiety
- Flu-like symptoms such as sweating or chills
Precipitated withdrawal symptoms can vary from person to person depending on a variety of factors. Some of these factors include your overall health, metabolism, and the severity of your opioid addiction.
How to Prevent Precipitated Withdrawal
The only way to prevent precipitated withdrawal from occurring is to get the timing right.
As a general rule of thumb, you should be experiencing mild to moderate withdrawal symptoms for at least a few hours before you can safely start taking buprenorphine.
If you are detoxing at an opioid detox center, the healthcare provider may use the Clinical Opioid Withdrawal Scale (COWS) to determine when you should start taking buprenorphine. The COWS looks at several factors, such as pulse rate, sweating, pupil size, body aches, runny nose, anxiety, irritability, tremors, and gastrointestinal upset, scoring these items on a scale based on severity.
When your COWS score is greater than 12 it is usually safe to start taking buprenorphine.
Be sure to be honest with your healthcare provider about when your last dose of opioids was, what kind of opioid it was, and whether or not you may have any other drugs in your system. You should also follow your prescriber’s instructions exactly. Doing so can prevent precipitated withdrawal.
Get Help for Opioid Abuse and Addiction
If you or a loved one suffer from opioid addiction, it’s time to seek professional help.
At First Step Behavioral Health, we understand how serious addiction to opiates is. We are passionate about helping people find freedom from their addiction and rebuild their lives on a strong foundation of recovery. We have a team of motivated and compassionate professionals that are dedicated to helping people recover. We are ready to answer any questions about opiate addiction and help where we can. Please give us a call today!
References:
- The National Institute of Drug Abuse (NIDA): Drug Overdose Death Rates, Retrieved June 2023 From https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
- The National Library of Medicine: Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department, Retrieved June 2023 From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871399/
- The National Library of Medicine: Managing opioid withdrawal precipitated by buprenorphine with buprenorphine, Retrieved June 2023 From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248003/
