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How to stop precipitated withdrawal

Buprenorphine/naloxone (Suboxone) binds preferentially over opioid agonists to opioid receptors in the body, “kicking off” the previous opioids and causing withdrawal symptoms during the induction phase. This is called “precipitated withdrawal.” That is why, before taking Suboxone, patients should be advised to discontinue all short-acting opioids like heroin, oxycodone, and fentanyl, at least 12 hours before taking Suboxone. Another good way to prevent precipitated withdrawal from occurring is waiting until you start to feel withdrawal symptoms after not having opioids and then taking your Suboxone. If you are on a longer-acting opioid such as methadone, you may require 24-48 hours before your body eliminates all of the opioid. Talk to your provider about the best strategy for avoiding precipitated withdrawal before starting Suboxone.

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Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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