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What is Precipitated Withdrawal?

Current pharmaceutical strategies to treat opioid use disorder (OUD) involve the safe administration of several FDA-approved medications to reduce cravings and manage withdrawal symptoms.1 However, the timing of starting these medications is crucial to avoid complications, such as precipitated withdrawal.2


Opioid Dependence and Precipitated Withdrawal

Precipitated withdrawal can be prompted by certain medications and is a phenomenon somewhat distinct from the withdrawal that arises as a result of slowing or stopping opioids.3 When opioids are in your system, they attach to and activate opioid receptors.4 If you have physical opioid dependence, decreasing opioid receptor activation—such as by decreasing or altogether stopping continued opioid use, or by administering opioid receptor antagonist or partial agonist medications—can result in an unpleasant acute opioid withdrawal syndrome.2,5

Withdrawal symptoms that occur when you stop using opioids typically appear gradually, with symptom severity peaking over the course of hours to days.6 In instances of pharmaceutically precipitated withdrawal, the symptoms arrive more suddenly, and can instantaneously peak in severity. Some medications used to treat an OUD can cause precipitated withdrawal if not used properly.6

Are you struggling with opioid misuse? If you are, the thought of withdrawal can be overwhelming. But you don’t have to do it alone. Reach out to one of our admissions navigators at and they can provide the information, support, and encouragement you need. The fear of the unknown doesn’t need to stop you from moving toward a safe recovery.


What Medications Could Cause Precipitated Withdrawal?

Some people experience symptoms of withdrawal when they stop taking opioid medications. To help get through some of these symptoms, many people benefit from the supportive care offered by a medical detox program. A professional treatment program can help you more comfortably stop opioid medications to better prepare you for more comprehensive treatment for opioid use disorder.1 Effective treatment may include counseling, therapy, or prescription medications.1 Treatment may also include a combination of these options.1

Medications used to help with withdrawal symptoms are safe and effective. However, it’s important to take these medications exactly as your doctor prescribes them.1 A healthcare professional will counsel you on the best way to take your medication and can monitor you should any complications arise. Timing of administration is important. For example, you may need to wait up to 10 days after you stop your drug use to begin taking certain medications for OUD, such as naltrexone.2

Some medications for opioid use disorder can cause precipitated withdrawal if you take them too soon after stopping opioids.2,5

Medications that may precipitate opioid withdrawal if administered incorrectly (i.e., at the wrong time) include:3

  • Buprenorphine.
  • Buprenorphine/naloxone (Suboxone).
  • Naloxone (Narcan).
  • Naltrexone (Vivitrol).


What Are the Symptoms of Precipitated Opioid Withdrawal?

Precipitated opioid withdrawal involves an accelerated onset of the characteristic set of acute opioid withdrawal symptoms.7

Acute opioid withdrawal symptoms include:5-7

  • Restlessness.
  • Anxiety.
  • Cravings.
  • Body aches.
  • Stomach cramps.
  • Nausea and vomiting.
  • Diarrhea.
  • Excessive sweating.
  • Chills and goosebumps.
  • Sweating.
  • Runny nose.


How to Avoid Precipitated Withdrawal

Although precipitated withdrawal may be elicited by the same medications that can help you manage opioid withdrawal symptoms, close monitoring by a treatment professional, carefully timed administration of treatment medications, as well as any adjustments to the treatment regimen can help you avoid precipitated withdrawal or, should it arise, have it managed effectively. Getting help from an addiction specialist or a treatment center when you’re ready to stop using opioids provides a safe way to begin your recovery. If your doctor prescribes medications to treat OUD, taking them exactly as prescribed will help avoid precipitated withdrawal.

The following are a few things you can do to avoid precipitated withdrawal:8,9

  • Let your treatment specialist know when you last used opioids and which drug you used.
  • Take medication for an OUD when your doctor advises.
  • Don’t take more or less medication than prescribed for an OUD.

Following the instructions from your treatment specialist will help you get through your initial treatment period without precipitated withdrawal.


Treating Precipitated Withdrawal

If you have symptoms of precipitated withdrawal, you can get help from a treatment specialist to safely treat your symptoms. Professionals in detox programs can prescribe medications to relieve your symptoms.

Medications that can help treat precipitated withdrawal include:6-10

  • Buprenorphine.
  • Lofexidine (Lucemyara).
  • Clonidine.
  • Ondansetron (Zofran).

Based on your individual needs, you can choose an outpatient program or residential inpatient rehab to help you on your road to recovery.


Sources

  1. Substance Abuse and Mental Health Services Administration. (2022). Medication-assisted treatment (MAT).
  2. Bisaga, A., Mannelli, P., Sullivan, M.A., Vosburg, S.K., Compton, P., Woody, G.E., & Kosten, T.R. (2018). Antagonists in the medical management of opioid use disorders: historical and existing treatment strategies. The American Journal on Addiction, 27, 177-187.
  3. The National Alliance of Advocates for Buprenorphine Treatment. (n.d.). What is precipitated withdrawal?
  4. National Institute on Drug Abuse. (2022). Medications for opioid overdose, withdrawal, & addiction.
  5. Whitley, S.D., Sohler, N.L., Kunins, H.V., Giovanniello, A., Li, X., Sacajiu, G., & Cunningham, C.O. (2016). Factors associated with complicated buprenorphine inductions. Journal of Substance Abuse Treatment, 39(1), 51-57.
  6. Haroz, R., Carroll, G.G., & Strayer, R.J. (2020). Treatment strategies for precipitated opioid withdrawal after naloxone rescue. ACEP Now, 39(2).
  7. Oakley, B., Wilson, H., Hayes, V., & Lintzeris, N. (2021). Managing opioid withdrawal precipitated by buprenorphine with buprenorphine. Drug and Alcohol Review, 40, 567-571.
  8. Whelan, P.J., & Remski, K. (2012) Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of Neurosciences in Rural Practice, 3(1), 45-50.
  9. Szczesniak, L.M., Calleo, V.J., & Sullivan, R.W. (2020). Buprenorphine therapy in the setting of induced opioid withdrawal from oral naltrexone: a case report. Harm Reduction Journal, 17, 71.
  10. Federal Drug Administration. (2018). Lofexidine.

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