What is precipitated withdrawal?

People with severe opioid addictions may turn to medication or medication assisted treatment (MAT) programs to end their addiction. The use of drugs that block the actions of opiods and help prevent cravings can be a powerful tool. Suboxone is an example of such a drug.

Suboxone is a combination of buprenorphine and naloxone. Buprenorphine helps reduce the urge to use opiods, and naloxone blocks their effects. Suboxone attaches to the same receptors in the brain as heroin or other opioids, but it does not produce the same level of euphoria/high. While this can serve as a very effective way to end addiction, using drugs like Suboxone at the wrong time can lead to a dangerous condition known as precipitated withdrawal.

What is Precipitated Withdrawal?

Precipated withdrawal occurs when a person has withdrawal symptoms that are related to a drug they are using to fight their addiction rather than the drug that got them addicted in the first place. It occurs because brain receptors that are used to powerful doses of heroin or other opioids are suddenly receiving a drug with lessened effects. This can trigger a sudden withdrawal rather than a more gradual one, and it is both painful and very dangerous. Severe dehydration, electrolyte imbalances and other health problems can result from precipitated withdrawal.

People with Suboxone withdrawal symptoms should seek medical care immediately, or alert their
medical team if they are in a treatment program and suddenly feel the symptoms of precipitated

Suboxone Withdrawal Symptoms

Once the brain and body are deprived of the drugs they expect, a chain reaction occurs that can bring on symptoms of withdrawal very quickly. Patients and doctors should watch closely for the following physical and mental symptoms:

• Dilated Pupils
• Fever
• Cramping
• Sweating
• Insomnia
• Muscle Aches
• Rapid Heart Beat

• High Blood Pressure
• Diarrhea
• Depression
• Suicidal Thoughts

How Long Does Precipitated Withdrawal Last?

Precipitated withdrawal can last only a few hours, or it can go on for days. The length of the withdrawal depends in part on the level of addiction, including the types and amounts of drugs taken. Some opioids stay in the body for a long time, and if they are still present when a patient starts Suboxone, the withdrawal period may last longer. The more general health of the patient also comes into play. Addicts often have very poor diets that lead to other medical problems. A body in poor health can also suffer from a longer withdrawal period.

How to Stop Precipitated Withdrawal

The key to stopping precipitated withdrawal is to prevent it in the first place. Addiction is a physical problem, which is why doctors now recognize it as a disease. Stopping precipitated withdrawal starts with recognizing the physical effects of opioids, and some of the mental effects of addiction. To stop sudden, violent withdrawal from the drug the brain expects, doctors should wait until patients have completely stopped using their drug of choice, it has left the body, and the person has also shown some minor signs of withdrawal.

To decide if patients have reached the point where it is safe to use medication to treat their
addiction, doctors use the Clinical Opiate Withdrawal Scale (COWS) to measure levels of both addiction and withdrawal. COWS measures 11 symptoms on a scale of 0-4, and patients shouldn’t start Suboxone until they reach a score of at least five or six. This score is an indication that some level of withdrawal has already started, thus reducing the chances of precipitated withdrawal. COWS measures:

  1. Pulse rate when the patient is at rest
  2. Excessive sweating
  3. Restlessness indicated by the ability to sit still
  4. Pupil size
  5. Aching joints and bones
  6. Teary eyes and a runny nose that are not accounted for by other problems such as allergies
  7. Diarrhea and vomiting
  8. Hand tremors
  9. Yawining
  10. Level of irritability or anxiety
  11. Goosebumps
    Once the assessment is complete, doctors create a score that indicates the level of withdrawal. This is
    where the balancing act comes into play. The ideal score for minimizing the risk of Suboxone withdrawal
    is between 5 and 12, so the body isn’t too shocked by the sudden lack of the expected drug, or so deep
    into its withdrawal that it may be safer to let it run its course without drug intervention.

These assessments continue after the first dose of Suboxone and at regular intervals to help doctors keep track of the effects of treatment. While continued withdrawal is expected, the key is to avoid a sudden precipitated withdrawal from Suboxone itself.

Using medications such as Suboxone has been proven to be highly effective in the fight against opioid addiction. It is important that the use of medication occurs with a doctor’s care, either as a prescription or as part of a medication assisted treatment program. Addicts who attempt to use these drugs on their own run the risk of increasing their chances of experiencing precipitated withdrawal. A trained professional knows the proper dosage, and knows when an addict is in a safe spot in their withdrawal to start medication.



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