Get Help & Answers Now

How can we help?

I'm ready to sign up! I have a few questions I want to refer someone Quiz: is Suboxone for me?

Precipitated Withdrawal & Sublocade | Signs & Symptoms

Danny Nieves-Kim, MD profile image
By Danny Nieves-Kim, MD • Updated Oct 15, 2023 • 6 cited sources

When administered properly, Sublocade will not cause precipitated withdrawal. Before your first Sublocade dose, you should have transitioned from drugs like heroin or OxyContin to oral buprenorphine.[1]

Video Thumbnail

But if you skip this step and transition directly from opioids to Sublocade injections, you may experience precipitated withdrawal. 

Knowing what precipitated withdrawal looks like is important. If you experience these symptoms, tell your doctor right away. 

What Is Precipitated Withdrawal?

Precipitated withdrawal is the sudden onset of severe withdrawal symptoms caused by the too-early introduction of Medication for Addiction Treatment (MAT) options.[3] 

Let’s break this down a bit. 

MAT options like Sublocade and Suboxone contain buprenorphine. This medication attaches to opioid receptors, the same ones used by drugs like prescription painkillers, heroin and fentanyl. It binds so tightly, in fact, that it can displace these drugs.[2]

If you introduce buprenorphine before your body has eliminated other opioids, they will be removed from their receptors. Since buprenorphine is a partial opioid agonist and has weaker opioid activity than opioids of misuse, its latching doesn’t seem like enough to your brain and body. Withdrawal symptoms appear. 

Doctors typically recommend waiting for the following time periods before starting buprenorphine:[3]

  • If you’re using short-acting opioids (like heroin, Percocet or Vicodin): 12 to 24 hours
  • If you’re using long-acting opioids (like fentanyl or methadone): 96 hours 

However, even waiting these recommended periods may not be enough. Reporters say some people who have been misusing fentanyl can experience precipitated withdrawal when beginning buprenorphine, even if they wait the recommended amount of time.[4]

Signs & Symptoms of Precipitated Withdrawal 

Physical and mental health changes associated with precipitated withdrawal are similar to those associated with regular withdrawal.[5] If you’ve ever tried to quit using opioids cold turkey, you’ve felt these problems in the past. 

But precipitated withdrawal symptoms appear suddenly. When they show up, they’re severe. 

Common signs of opioid withdrawal include the following:[5]

  • Fast pulse
  • Sweating
  • Restlessness
  • Large pupils
  • Aching bones and joints
  • Runny nose
  • Watery eyes 
  • Gastrointestinal upset
  • Shaking 
  • Anxiety 
  • Goosebumps 

People experiencing a standard withdrawal process will notice signs that then worsen. People experiencing precipitated withdrawal will only notice signs when they are severe. 

How to Prevent Precipitated Withdrawal 

The FDA recommends that you don’t start Sublocade until you have been on oral buprenorphine (like Suboxone) for at least 7 days. This is the safest and most effective way to ensure your Sublocade won’t cause precipitated withdrawal. [1]

Oral buprenorphine products can cause precipitated withdrawal too, especially if you take them too early.

Wait the recommended time frames before you take your first buprenorphine dose. Watch for subtle signs of withdrawal, and tell your doctor when they appear. 

You shouldn’t be in full-blown, excruciating withdrawal when you start your first buprenorphine dose. But you should be experiencing moderate signs of discomfort. They prove that your body has processed almost all of the drugs you took. You’re ready to start MAT with a lowered risk of precipitated withdrawal. 

Your doctor will guide you through the process of initiating buprenorphine use. Oftentimes, doctors prescribe Suboxone (buprenorphine/naloxone) initially. After stabilization, they may then move patients to Sublocade if it fits with their goals and overall treatment plan.

How to Help Yourself Through Precipitated Withdrawal 

If you experience precipitated withdrawal from any MAT option, talk to your doctor. Together, you can decide on a treatment plan that prevents relapse. 

Treatment for precipitated withdrawal typically involves the following steps:[2,6]

  • Medications: Antiemetics, antidiarrheals and over-the-counter pain medications may all be part of your treatment plan. The goal is to keep symptoms under control.
  • Fluids: Cool drinks with electrolytes can help you replace fluids lost through sweating and GI upset, such as vomiting or diarrhea. 
  • Supportive environment: It can be helpful to have a safe, supportive setting when managing precipitated withdrawal. This may also lessen the risk of returning to opioid use. You can get further support by reaching out to your doctor about completing the induction.

Planning is the best way to avoid precipitated withdrawal. But know that your doctor can help if anything goes wrong. 

How to Help Someone Else Through Precipitated Withdrawal 

If you’re supporting someone else moving from opioid misuse to MAT with buprenorphine, watch for precipitated withdrawal symptoms. If you spot them, call the person’s doctor. 

Stay with the person and offer your encouragement and support. The person is at risk of returning to opioid misuse. Your presence could make that less likely. While medical supervision to guide the process is ideal, you can offer support as they deal with the process.

By Danny Nieves-Kim, MD

... Read More

  1. Sublocade prescribing information. U.S. Food and Drug Administration. Published March 2021. Accessed August 17, 2023.
  2. Buprenorphine quick start guide. Substance Abuse and Mental Health Services Administration. Accessed August 17, 2023.
  3. Precipitated withdrawal. National Alliance of Advocates for Buprenorphine Treatment. Published 2007. Accessed August 17, 2023. 
  4. Facher L. To ease the start of addiction treatment, doctors find surprise aid: ketamine. Stat. Published May 8, 2023. Accessed August 17, 2023. 
  5. Dunn KE, Bird HE, Bergeria CL, Ware OD, Strain EC, Huhn AS. Operational definition of precipitated opioid withdrawal. Front Psychiatry. 2023;14:1141980. Published 2023 Apr 20. doi:10.3389/fpsyt.2023.1141980
  6. Oakley B, Wilson H, Hayes V, Lintzeris N. Managing opioid withdrawal precipitated by buprenorphine with buprenorphine. Drug Alcohol Rev. 2021;40(4):567-571. doi:10.1111/dar.13228

Download Our Free Program Guide

Learn about our program, its effectiveness and what to expect

Safe, effective Suboxone treatment from home. Learn More

Imagine what’s possible on the other side of opioid use disorder.

Our science-backed approach boasts 95% of patients reporting no withdrawal symptoms at 7 days. We can help you achieve easier days and a happier future.