What is precipitated withdrawal?

December 18, 2022

What is precipitated withdrawal? Precipitated withdrawal occurs when taking a medication called buprenorphine while still on opiates or opioids. Buprenorphine (naloxone) is a medication designed to treat opiate use disorder, or addiction. It blocks opiate receptors in the brain and spinal cord, while at the same time having a weak opioid-effect on these receptors, thereby stopping the cravings, helping patients to quit using opiates such as heroin. 

This medication can be cause precipitous withdrawals when a patient decides to take it too early, without letting his or her opiate of choice wear off first. This causes the opioids that are still in the blood and on the opioid receptors to be rapidly replaced by buprenorphine, without giving the body time to get used to the lower opioid activity. This can lead to severe opioid withdrawal symptoms, called precipitated withdrawal. These signs and symptoms can include: 

  • Pain, including headaches
  • Anxiety
  • Diarrhea
  • Nausea and vomiting
  • Runny nose
  • Goosebumps
  • Chills

For this reason, it is always best to wait until detoxification has begun before beginning this medication. In other words, the person should already be in an early withdrawal state before starting buprenorphine-containing medications like Suboxone. For most opioids the waiting period should be at least 24 hours. For fentanyl and methadone it should be 2-3 days. Microdosing may help reduce the risk of precipitated withdrawals. 

Where to Get Suboxone?

QuickMD is the largest TeleMAT service in the US, treating tens of thousands of patients for opioid-use disorder and reaching even the most rural areas in the United States. Our patients get prescribed Suboxone via telemedicine and can pick up their medications at their local pharmacy or get it mailed to their home (in many states).