Is Suboxone treatment a fit for you?
Find out now

How to stop precipitated withdrawal

Some people may experience powerful withdrawal symptoms shortly after initiating Suboxone. This condition is called Suboxone precipitated withdrawal

There is no reason to avoid starting Suboxone out of fear of precipitated withdrawal. The benefits of Suboxone greatly outweigh the risks, and precipitated withdrawal is avoidable with a bit of knowledge and careful planning. 

What is precipitated withdrawal? 

Precipitated withdrawal is the sudden onset of intense withdrawal symptoms that can occur after taking certain medications to treat an opioid overdose or opioid use disorder (OUD).[1,4]

This form of withdrawal occurs immediately after someone is saved from an overdose with naloxone or in the hours after starting Suboxone.[1,4-6] 

To really understand how precipitated withdrawal works, you need to understand what’s behind regular withdrawal.

What happens during withdrawal? 

Withdrawal is how the brain responds to lower-than-expected opioid signaling.

Receptors are proteins on cells that are activated when specific molecules bind to them. When receptors are activated, they respond with a process called signaling, which sends messages to other cells and other parts of the same cell.[8] Opioid drugs bind to aptly named opioid receptors. 

Opioid receptors are scattered all across the body and are concentrated heavily in the brain, spine, and gastrointestinal tract. Opioid signaling in the brain plays a crucial role in pain, breathing, and pleasure.[8,9]

When opioids activate these receptors, the increased opioid signaling can cause pain relief and euphoria. In people with OUD, constant opioid use trains the brain to expect a higher baseline level of opioid signaling.[8] 

When someone with physical dependence stops taking opioids, opioid signaling in the brain drops below what it now considers normal.[3,7] This causes feelings of significant discomfort in the form of withdrawal symptoms.

What causes precipitated withdrawal?

Precipitated withdrawal is caused by a medicine sharply reducing opioid signaling in the brain.[1] 

For example, the overdose rescue drug naloxone reverses the effects of an opioid overdose by strongly blocking opioid receptors. However, the sudden drop of opioid signaling triggers near-immediate severe withdrawal symptoms.[10] 

Suboxone precipitated withdrawal

Suboxone sometimes causes precipitated withdrawal because it can decrease opioid receptor activity in certain situations. The buprenorphine in Suboxone binds very strongly to opioid receptors but only weakly activates opioid signaling.[1,11] 

Medication for Addiction Treatment with Suboxone is effective because that small amount of opioid signaling is just enough to reduce withdrawal symptoms without causing a high.[11] However, this can be a problem if someone still has opioids in their system

When buprenorphine binds to an opioid receptor, it displaces other opioid drugs.[1,5] Replacing strong signaling from another opioid with buprenorphine’s relatively weak signaling causes a net decrease that triggers withdrawal.[11] 

Symptoms of withdrawal from Suboxone

The symptoms of Suboxone precipitated withdrawal are intense versions of typical opioid withdrawal.[1,7] These symptoms include:

  • Cold sweats
  • Anxiety
  • Opioid cravings
  • Nausea
  • Diarrhea
  • Abdominal cramps

How long does Suboxone precipitated withdrawal last?

Suboxone precipitated withdrawal typically kicks in within the first hour and a half of taking it. 

After symptoms begin, they tend to peak between 1.5 and 3 hours. After the peak, symptoms slowly subside over the next couple of hours.[1] 

How to stop Suboxone precipitated withdrawal

Surprisingly, Suboxone can help treat Suboxone precipitated withdrawal.[1,13,14] This seems like a paradox, but the effects of Suboxone depend on how long a person has been off other opioids.

Suboxone only causes precipitated withdrawal if it displaces a more potent opioid and decreases opioid signaling. If no other drug is present to replace, buprenorphine stimulates opioid receptor activity as intended and reduces withdrawal symptoms.[1,11,12]

Taking another opioid can stop Suboxone precipitated withdrawal, but this should be avoided if at all possible. 

If you do take another opioid to treat the precipitated withdrawal, make sure to give yourself some time before you try retaking Suboxone.[1] The amount of time to wait depends on the drug, but the best bet is to wait until you start feeling normal withdrawal symptoms from the opioid you took.

Can you prevent Suboxone precipitated withdrawal?

Suboxone precipitated withdrawal is preventable; the key is timing. 

The general rule is that Suboxone should be initiated when opioid concentrations are as low as possible. However, exact estimates are difficult, as different drugs clear the body at different rates and everyone’s body is different.

This may take 4-6 hours for some opioids, while other drugs can take as long as three days.[1] 

The most reliable way to prevent Suboxone precipitated withdrawal is to get treatment under careful medical supervision. If that isn’t possible, a general rule is to wait until you start to feel withdrawal symptoms

Waiting it out will be uncomfortable but not as unpleasant as precipitated withdrawal.

Regardless, remember that the risk of Suboxone precipitated withdrawal is nothing compared to the risk of opioid misuse. An awful couple of hours from Suboxone is nothing compared to death or a lifelong disability from an opioid overdose. Suboxone is safe, effective, and saves lives.

Citations

1. Jones, H.E., Practical considerations for the clinical use of buprenorphine. Sci Pract Perspect, 2004. 2(2): p. 4-20.

2. Larochelle, M.R., et al., Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Ann Intern Med, 2018. 169(3): p. 137-145.

3. Shah, M. and M.R. Huecker, Opioid Withdrawal, in StatPearls. 2021: Treasure Island (FL).

4. Kanof, P.D., et al., Clinical characteristics of naloxone-precipitated withdrawal in human opioid-dependent subjects. J Pharmacol Exp Ther, 1992. 260(1): p. 355-63.

5. Rosado, J., et al., Sublingual buprenorphine/naloxone precipitated withdrawal in subjects maintained on 100mg of daily methadone. Drug Alcohol Depend, 2007. 90(2-3): p. 261-9.

6. Bhatia, G. and S. Sarkar, Sublingual buprenorphine-naloxone precipitated withdrawal-A case report with review of literature and clinical considerations. Asian J Psychiatr, 2020. 53: p. 102121.

7. Gupta, M., S.B. Gokarakonda, and F.N. Attia, Withdrawal Syndromes, in StatPearls. 2021: Treasure Island (FL).

8. Kosten, T.R. and T.P. George, The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect, 2002. 1(1): p. 13-20.

9. Theriot, J., S. Sabir, and M. Azadfard, Opioid Antagonists, in StatPearls. 2021: Treasure Island (FL).

10. Jordan, M.R. and D. Morrisonponce, Naloxone, in StatPearls. 2021: Treasure Island (FL).

11. Kumar, R., O. Viswanath, and A. Saadabadi, Buprenorphine, in StatPearls. 2021: Treasure Island (FL).

12. Whitley, S.D., et al., Factors associated with complicated buprenorphine inductions. J Subst Abuse Treat, 2010. 39(1): p. 51-7.

13. Quattlebaum, T.H.N., M. Kiyokawa, and K.A. Murata, A case of buprenorphine-precipitated withdrawal managed with high-dose buprenorphine. Fam Pract, 2021.

14. Oakley, B., et al., Managing opioid withdrawal precipitated by buprenorphine with buprenorphine. Drug Alcohol Rev, 2021. 40(4): p. 567-571.


Lorelei Tucker, PhD

Lorelei Tucker has a PhD in Neuroscience from Augusta University and a BS in Chemistry from Georgia Southern University. Lorelei has worked as a research assistant at Augusta University and is currently working as a medical writer with The Med Writers.

Is Suboxone treatment a fit for you?

Contact us directly to speak with a specialist.

Lorelei Tucker, PhD

Lorelei Tucker has a PhD in Neuroscience from Augusta University and a BS in Chemistry from Georgia Southern University. Lorelei has worked as a research assistant at Augusta University and is currently working as a medical writer with The Med Writers.

Bicycle Health Online Suboxone Doctors

Safe, confidential, & affordable treatment for opioid use disorder.
Learn More