What is Precipitated Withdrawal? Drugs That Can Cause Precipitated Withdrawal
Because the withdrawal is what to do if you have been roofied caused, or precipitated, by the new drug, this phenomenon is called precipitated withdrawal. In January 2022, the Food and Drug Administration (FDA) issued a warning related to dental problems caused by buprenorphine when administered by dissolving in the mouth. This warning follows reports of dental problems including tooth decay, cavities, oral infections, and loss of teeth. This serious adverse effect can occur whether or not you’ve had a history of dental problems.
How is it treated?
The patient had been prescribed methadone some years ago as a treatment for opiate dependence. On discharge review, he reported last taking a 10 mg tablet of methadone sometime in the week prior to presenting for bup/nx induction but he was unsure when. The long‐acting nature of methadone is the possible cause of the significant precipitated withdrawal, and is a particular point that our clinic needs to ensure we clearly educate and question our clients about prior to induction. Point of care urine drug screening is an additional tool that practitioners can utilise to reduce the risks of precipitated withdrawal, and complements thorough history taking and education of patients.
Precipitated withdrawal occurs when a person who is dependent on opiates develops sudden and severe withdrawal symptoms due to the effect of buprenorphine. Understanding how medically-assisted treatment with buprenorphine works is crucial to grasp how precipitated withdrawal can occur. However, the only way for a person to be in a position to overcome a psychological compulsion to abuse opioids is to break the physical compulsion, and that comes through detoxification.
- To avoid precipitated withdrawal, Sublocade should only be administered after withdrawal symptoms have already appeared.
- This means it should ease symptoms without triggering the full effect of an opioid.
- This could be your primary care provider, a doctor at a drug rehab, or staff at an emergency room or urgent care.
- The symptoms of precipitated withdrawal vary depending on the opioid.
- A person should be opioid-free for at least seven to 10 days before starting the drug.
Prevention Strategies for Precipitated Opioid Withdrawal
The symptoms of precipitated withdrawal are more severe than spontaneous opioid withdrawal. If these drugs are taken too early during the detox process, they can bring on sudden and severe withdrawal symptoms. Heroin is an effective opioid due to how it activates and subsequently binds to the brain’s opioid receptors. Once heroin latches onto these receptors, it induces euphoria, alters cell function, and ultimately can lead to addiction.
Recovery and Long-Term Support
However, stopping treatment early increases the risk of using opioids again. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers. The best way to avoid precipitated withdrawal is to make sure your doctor and pharmacist know all the medicines you are taking.
He had attempted treatment with sublingual bup/nx at a community pharmacy but had used heroin prior to this and suffered mild opioid withdrawal symptoms, and did not continue with treatment at this time. He had a comprehensive assessment at a specialist public drug and alcohol facility. He was educated about bup/nx treatment, including risks of precipitated withdrawal in the setting of methadone use, and given the opportunity to ask questions, as per the service’s usual practice. In some cases, naloxone is used to purposely trigger a precipitated withdrawal in the event of an opioid overdose.6However, it is also an ingredient in the opioid detox treatment medication Suboxone. It is included to help patients avoid whats in whippets relapse if they misuse Suboxone by injecting it.7 Knowing that taking an opioid in this way will trigger precipitated withdrawal can be helpful in discouraging opioid misuse.
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This is a well‐recognised adverse outcome from buprenorphine induction 3, 4, 5, and was found to occur in 9% of buprenorphine inductions 6. Risk factors for precipitated withdrawal include transferring from long‐acting agents such as methadone, recent benzodiazepine use, no past patient experience with buprenorphine, and a low initial dose of buprenorphine/naloxone 6. Opioid antagonists work by blocking opioid receptors in your body from receiving reward signals from opioids in your system.
A possible reason for this reaction is that all the opioid receptors are blocked all at once in POW. Therefore, acute withdrawal symptoms may have a slower start before they fully kick in. Sublocade contains buprenorphine, which, when administered improperly, can cause precipitated withdrawal. To avoid precipitated withdrawal, Sublocade should only be administered after withdrawal symptoms have already appeared. Sublocade titration, or starting with a lower dose and then gradually raising it, can also prevent Sublocade-induced precipitated withdrawal. Precipitated withdrawal is withdrawal that is induced by an opioid treatment maverick sober living medication.