What Is Precipitated Withdrawal? Tips for Taking Suboxone®

Opioid withdrawal isn’t an easy process — in fact, it can be so severe that merely hearing rehab veterans talk about it can make some users avoid treatment altogether. This is why drugs like Suboxone® — the brand-name medication that combines the active ingredients buprenorphine and naloxone — are so popular. These drugs offer a way to lessen the effects of opioid/opiate withdrawal. But Suboxone® withdrawal is also real and in some cases can be severe.

Picture this: You get a prescription for Vicodin, an opioid pain reliever, for pain after routine surgery. Because of the hyper-addictive nature of most prescription painkillers, a single month can be more than enough time for dependency to set in. You get a refill.

As you continue its use, you find it harder and harder to function without the influence of the drug, causing you to become physically dependent on it. One day, you decide you need to stop your opioid dependence. So you visit a clinic where you’re prescribed Suboxone® as the latest and best treatment for opioid use disorder (OUD).

But if you don’t wait long enough to take your first dose, it can be dangerous. Taking Suboxone® treatment after Vicodin, while the opioid is still in your system, can cause what’s known as precipitated withdrawal.

What Is Precipitated Withdrawal?

Precipitated withdrawal is a rapid and severe form of withdrawal that occurs as a result of certain types of treatment. In most cases, it’s caused by taking a medication like Suboxone® at the wrong time during recovery.

What Are Symptoms of Precipitated Withdrawal?

The symptoms of precipitated withdrawal mirror the signs of primary withdrawal from opioids and opiates such as heroin, morphine and prescription pain pills.

A person going through withdrawal may experience some or all of the following symptoms:

• Fever and sweating
• Muscle cramping and aches
• Nausea, vomiting and diarrhea
• Increased heart rate, flushing of the skin and dilated pupils
• Feelings of depression and suicidal thoughts

The severity of the withdrawal symptoms varies based on the length of the individual’s dependency or addiction and, in the case of Suboxone® withdrawal, the amount of the primary drug in their system when Suboxone® was administered.

What Causes Precipitated Withdrawal?

Suboxone® is a drug used to make withdrawal less severe through a combination of buprenorphine and naloxone. Buprenorphine is generally considered a safe version of more addictive opioids. Naloxone, the same drug found in Narcan, effectively limits the potential to abuse the drug.

Precipitated withdrawal is essentially system shock. Your body is used to feeling the effects of an opioid or opiate. It functions in a way that’s become normal due to the presence of these drugs. Suddenly something milder — buprenorphine — replaces that, and it may trigger withdrawal symptoms.

Studies have shown that precipitated withdrawal is most likely to occur when buprenorphine-naloxone is used while patients are still actively under the influence of an opioid or opiate.

How Do You Mitigate/Avoid Precipitated Withdrawal?

Precipitated withdrawal can be very severe and unpleasant. It’s not just difficult for a person to handle; it threatens their successful recovery. When a person addicted to a substance enters withdrawal, the only thing that will relieve it is using that substance. The worse they feel due to the effects of withdrawal, the more likely it is that they’ll use again.

With this in mind, it’s important to use buprenorphine-naloxone in a responsible way. The goal is to keep withdrawal symptoms under control while lessening the risk of precipitated withdrawal.

The Underlying Chemical Causes

You’ll need to understand the chemical interactions happening in your brain when you start taking buprenorphine-naloxone.

Buprenorphine, one of the two active chemical ingredients in Suboxone®, is known as a partial opioid agonist. This means it’s less potent than drugs like heroin or prescription opioids, which are full opioid agonists. Put simply, Suboxone® can activate the opioid receptors in the brain, but to a lesser degree. This makes it effective in helping scale back drug use in a controlled way.

This is useful in helping individuals avoid full-blown withdrawal — except in certain situations. For example, if you take Suboxone® with opiates in your system, it may replace the opioid molecules already attached to receptors in your brain. The resulting weakened effect may cause a precipitated withdrawal.

When Is the Best Time to Start MAT?

Medication-assisted treatment (MAT) is an evidence-based treatment method shown to be effective, especially for people with opioid use disorder (OUD). MAT is the clinical term for prescribing buprenorphine-naloxone as part of substance abuse treatment. The intended outcome is to lessen withdrawal and make it easier to stop using heroin and other opioids/opiates.

But the risk of precipitated withdrawal shows that MAT — like everything else — needs to be strategized and used at the optimal time, and this varies between individuals.

Experts recommend starting buprenorphine-naloxone after a person is already experiencing the early symptoms of withdrawal from their preferred substance(s). Once the process increases in severity, as measured on the clinical opiate withdrawal scale (COWS), the risk for precipitated withdrawal is reduced. This is because there’s a decreased chance of the sudden involvement of a partial agonist shocking the system.

Why Is It Dangerous to Use Suboxone® at Home?

Suboxone® has been hailed as a miracle drug, primarily for two reasons:

• It doesn’t have to be consumed in a clinic like methadone does. It can be prescribed by any licensed, Suboxone®-certified physician.
• It carries a lower risk for abuse and dependency than methadone, meaning people using buprenorphine have a chance to become completely clean sooner.

In spite of these proven benefits, opioid withdrawal is still a real risk, and there’s always the chance that unexpected circumstances may arise. This is why it’s so important for Suboxone® and similar drugs to be administered by professionals, preferably in a clinical detox setting. It’s also why it is extremely important not to use the medication outside the prescription of a doctor.

Responsible MAT at FHE Health

Even with the latest and most promising approaches to recovery (like MAT), the risk of complications such as precipitated withdrawal are still present. At FHE Health, everything we do is personalized to the individual needs of our clients. If you or a loved one is abusing opioids, contact us. We can help get you back on your feet and ready to rebuild your life.