Precipitated withdrawal symptoms emerge if someone who is dependent on opioids takes certain medications for addiction treatment (MAT) too early while opioids are still active—these include buprenorphine, Suboxone, Sublocade, naltrexone and naloxone.
You can prevent or avoid precipitated withdrawal by carefully following your doctor’s instructions on when to take your Suboxone or naltrexone. However, if you do experience these symptoms, there are ways to treat, manage, and stop them.
There is no reason to avoid starting Suboxone or Sublocade out of fear of precipitated withdrawal. The benefits of MAT greatly outweigh the risks, and precipitated withdrawal is avoidable with a bit of knowledge, careful planning and communication with your doctor.
How do you stop precipitated withdrawal?
Quick Answer
Precipitated withdrawal symptoms can occur when you take MAT options too soon like naltrexone, Suboxone, Sublocade, or the overdose antidote, naloxone. The best way to stop them is to prevent them by waiting the appropriate time before taking your MAT.
Otherwise, if you are experiencing symptoms, you can use OTC pain relievers, Pepto Bismol, and Immodium, as well as engage in self-care practices like hydrating, resting, taking vitamin supplements, and eating nutritious foods.
How to Prevent or Treat Precipitated Withdrawal Symptoms
Precipitated withdrawal symptoms occur when you are dependent on opioids and take another medication, such as buprenorphine, Suboxone, naltrexone or naloxone, before the opioid has left your body. Taking this medication too soon induces opioid withdrawal symptoms, such as: [1]
- Flu-like symptoms
- Anxiety
- Tremors
- Stomach cramping
- Goosebumps
- Muscle aches
These precipitated withdrawal symptoms can range from mildly uncomfortable to extremely distressing and painful, depending on how severe your dependence and opioid use disorder is.
The best way to stop precipitated withdrawal is to prevent its emergence. You can do this by listening to your doctor’s MAT dosing instructions and following their recommendations carefully.
Listening to your provider will ensure that you’ve waited the appropriate time after using an opioid before taking your Suboxone or naltrexone.
However, if you do take your medication too early or end up receiving a dose of naloxone (Narcan) for an overdose, you will experience precipitated withdrawal. The good news is these symptoms only last for a few hours to a day or so, and you can possibly manage these symptoms at home.
Tips for Managing Precipitated Withdrawal
If you are experiencing painful symptoms, such as fever, nausea, vomiting, stomach cramping, or muscle aches, here are some tips for treating and avoiding precipitated withdrawal: [2], [3], [4], [5]
- OTC pain relievers: Try Advil, aspirin, or Tylenol for any muscle or joint pains you may be experiencing.
- Topical analgesic: For muscle aches and pains, you can always try a topical pain reliever like Tiger Balm or Ben Gay.
- Pepto Bismol: Pepto Bismol can help manage the nausea and vomiting associated with precipitated withdrawal.
- Imodium: Imodium (loperamide hydrochloride) can help treat severe diarrhea.
- Eat healthy: Opioid misuse can lead to many nutritional deficiencies, such as calcium and magnesium. Eating a nutritious, well-balanced diet can help correct deficiencies and keep you healthy during withdrawal.
- Vitamin supplements: Taking a multivitamin or taking specific vitamins for deficiencies can also improve your health and ease your symptoms. Experts recommend vitamin B and vitamin C supplements specifically.
- Hydration: Experts recommend between eight and 12 cups of water per day to replace water lost through sweat, diarrhea and vomiting during opioid withdrawal.
- Hydrotherapy: Taking a hot bath with Epsom salts may help relieve muscle or joint aches as well as stomach cramping. It can also help enhance relaxation during precipitated withdrawal.
- Rest: It’s important that you listen to your body and get as much rest as possible during this time. Take naps if you can and make sure you go to bed early and get at least eight hours of sleep at night. Practice good sleep hygiene around bedtime by limiting screens.
- Natural sleep supplements: If you are having trouble falling or staying asleep, try a natural sleep supplement like melatonin.
- Distraction: Precipitated withdrawal symptoms can be very distressing and overwhelming so it might help to distract yourself with something that you love, such as listening to music, watching a favorite movie or TV show, reading a book or playing a video game.
- Joyful movement or exercise: If you are feeling up to it, you might want to try exercising a bit to try to manage some of your symptoms, such as anxiety, depression, or restlessness. Exercising also releases endorphins, which bind to the opioid receptors in the brain, possibly providing a bit of relief. Make sure to pick an activity that you enjoy—exercise doesn’t have to mean a high-intensity workout or lifting session. It could mean going for a hike, walking your dog, or dancing.
Buprenorphine: A Strategy for Stopping Precipitated Withdrawal Symptoms
Although buprenorphine could very well be the medication that caused you to go into precipitated withdrawal, it can also be used to treat and manage precipitated withdrawal symptoms. [6]
This is because precipitated withdrawal symptoms are the same as opioid withdrawal, which is commonly treated with buprenorphine (not to be confused with Suboxone which also has naloxone in it). [6]
If you are experiencing particularly severe precipitated withdrawal symptoms, you might want to give your doctor or provider a call. They could call in a buprenorphine prescription for you to pick up at your pharmacy. Of course, this all depends on your provider’s availability and recommendations, but it may be worth asking.
It’s understandable if you’re feeling hesitant about taking buprenorphine for precipitated withdrawal, especially if it played a role in bringing about your symptoms. However, you’ll find that it can make you feel a lot better.
Plus, once you take the buprenorphine for precipitated withdrawal, you will already be set up to take buprenorphine long-term for MAT, if that’s the course that you would like to take.
When to Seek Emergency Attention
Precipitated withdrawal symptoms are rarely dangerous but it’s important to understand that complications can occur. This is especially true if you have underlying health issues, such as a heart condition, or a co-occurring mental health disorder, such as depression, posttraumatic stress disorder (PTSD), bipolar disorder, or borderline personality disorder.
Signs that you should call 911 or go to an emergency room include:
- Suicidal thoughts or behaviors
- Hallucinations or other symptoms of psychosis
- Unconsciousness or coma
- Severe confusion
- Inability to talk or move
- Severe dizziness
If you are pregnant, you should go to the ER immediately—it’s not recommended that pregnant people go through precipitated or opioid withdrawal since this can cause premature delivery or miscarriage. [3]
Starting Suboxone or Sublocade After Going Through Precipitated Withdrawal
Although precipitated withdrawal can be stressful and nerve-racking, it shouldn’t deter you from getting the help you need to recover from opioid use disorder in the long run.
Medications for addiction treatment, such as Suboxone, Sublocade, methadone and naltrexone, have proven extremely successful in helping people maintain long-term sobriety. These opioid use disorder medications have countless benefits, including: [7]
- Increased treatment retention (meaning you stay in treatment longer)
- Reduced opioid misuse
- Improved patient ability to get and keep jobs
- Improved patient survival
- Improved social and family life
- Improved birth outcomes for pregnant people
If you want to start Suboxone therapy or the monthly injection, Sublocade, you can visit a buprenorphine doctor either in person or online to get evaluated and learn more about how the process works.
By Peter Manza, PhD
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More
- Opiate and opioid withdrawal (2022) MedlinePlus. Available at: https://medlineplus.gov/ency/article/000949.htm (Accessed: 08 June 2023).
- Nabipour, Sepideh et al. “Burden and nutritional deficiencies in opiate addiction- systematic review article.” Iranian journal of public health vol. 43,8 (2014): 1022-32.
- ‘Withdrawal Management’ (2009) in Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. Manila: World Health Organization, Western Pacific Region.
- Arida RM, Gomes da Silva S, de Almeida AA, et al. Differential effects of exercise on brain opioid receptor binding and activation in rats. J Neurochem. 2015;132(2):206-217. doi:10.1111/jnc.12976
- Weinstock J, Wadeson HK, VanHeest JL. Exercise as an adjunct treatment for opiate agonist treatment: review of the current research and implementation strategies. Subst Abus. 2012;33(4):350-360. doi:10.1080/08897077.2012.663327
- 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
- Medications for substance use disorders (2023) Substance Abuse and Mental Health Services Administration. Available at: https://www.samhsa.gov/medications-substance-use-disorders (Accessed: 08 June 2023).
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