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Precipitated Withdrawal

Withdrawal usually refers to the sensations and symptoms someone experiences when they stop using an addictive substance. Precipitated withdrawal, however, refers to withdrawal caused by a medication.

Substances like Suboxone and Naloxone can be helpful resources for medically-assisted recovery from opioid addiction. Without careful application and monitoring, however, they have the potential to trigger precipitated withdrawal, which can be as life-threatening as withdrawal from illicit drugs.

Precipitated withdrawal most commonly occurs in individuals dealing with opioid dependence.

Unlike typical withdrawals, precipitated withdrawal refers to withdrawal caused by a medication.

Causes of Opioid Withdrawal

People most often experience withdrawal symptoms when they eliminate or significantly decrease the amount of an addictive substance they’ve been taking for a while.

This may occur as a result of an addiction to opioids purchased on the street, or even a developed dependence upon prescription drugs.

During the development of a dependence, an individual’s body becomes accustomed to functioning with the substance present. Thus, taking illegal or prescription drugs over a long period of time conditions the body to expect those effects regularly.

When the substance is removed suddenly, the body goes into a sort of panic mode without the substance it has adapted to. This reaction manifests as uncomfortable physical and mental symptoms that can be life-threatening.

Symptoms of Opioid Withdrawal

Medically-approved opioids are most often prescribed to relieve pain in some capacity. Their side effects usually produce feelings of euphoria and relaxation.

The “desirable” effects of a drug are often precisely opposite in nature to the symptoms of its withdrawal.

It’s interesting to note that the “desirable” effects of a drug are often precisely opposite in nature to the symptoms of its withdrawal. For example, as the following list of opioid withdrawal symptoms shows, many symptoms have to do with hyperactivity in the body – the opposite of calm and relaxation:

  • Muscle aches
  • Vomiting
  • Diarrhea
  • Dilated pupils
  • Light sensitivity
  • Insomnia
  • Rapid breathing
  • Overactive reflexes
  • Fast heartbeat
  • Sweating
  • Overheating
  • High blood pressure

Dealing With and Avoiding Precipitated Withdrawal

Precipitated withdrawal most often occurs as a result of prematurely applied medications that combat opioid withdrawal, such as Suboxone or buprenorphine.

Precipitated Withdrawal Causes

Because buprenorphine has a higher binding strength than opioids to the opioid receptor, it “kicks off” the opioid and replaces it. However, buprenorphine activates the receptor to a lesser degree than the opioid, causing the patient to experience withdrawal symptoms due to a net loss of opioid effects.

This substitution can be helpful as part of a steady transition away from opioid addiction. For patients who are dealing with opioid withdrawal, buprenorphine can act as a “stepping stone” between opioid dependence and sobriety.

Buprenorphine administered too early in the detoxification process, however, means a large amount of these opioid receptors are getting “kicked off” at the same time, resulting in rapid onset precipitated withdrawal.

Precipitated Withdrawal Symptoms

Precipitated withdrawal symptoms are not unique or different from those associated with opioid withdrawal. Due to their severity, however, in addition to those listed above, precipitated withdrawal symptoms, may include:

  • Fever
  • Cramping
  • Insomnia
  • Depression
  • Suicidal thoughts

Since buprenorphine is an opioid in itself, the danger of precipitated withdrawal comes not from the symptoms themselves, but from the severity of these symptoms, which can quickly become life-threatening.

Precipitated withdrawal symptoms:   Fever  Cramping Insomnia Depression Suicidal thoughts

Avoiding Precipitated Withdrawal

To avoid painful withdrawal symptoms, patients should not be given their first dose of buprenorphine until after they are already in mild to moderate withdrawal – and definitely not while they’re still high on opioids.

The type of opioid a person has been using also plays an important role in determining how much time passes before they can take buprenorphine. Opioids come in both long-acting and short-acting forms. Long-acting opioids such as Oxycontin and methadone will require a longer period of abstinence than short-acting ones that include heroin, crushed Oxycontin, Percocet, Vicodin, oxycodone, and others.

Medical supervision can also be pivotal to help avoid developing an addiction to Suboxone – the very medication meant to help opioid dependence. As an opioid itself, Suboxone has a high potential to trigger its own withdrawals if not taken correctly.

The appropriate withdrawal stage for Suboxone administration should be determined by a trained professional who assesses appropriate timing based on the patient’s last use of all opioids, objective and subjective symptoms, and a COWS (Clinical Opioid Withdrawal Scale) score calculation.

Safe Opioid Addiction Recovery

Avoiding severe precipitated withdrawal requires a delicate balance of timing and understanding of the body. This is why it should never be attempted at home.

Additionally, experiencing the pain of precipitated withdrawal may motivate some not to seek out treatment for their opioid addiction, further deepening their addiction. While clinically monitored withdrawal is still painful, it is the safest way to go through the necessary detoxification process on the road to recovery.

If you think a loved one is suffering from an opioid addiction, contact us today. Our caring professionals are ready and willing to help walk addiction sufferers through the detox process and on to a life of sobriety.