Precipitated withdrawal is a condition that occurs when a person with a dependence on full agonist opioids (e.g., heroin or fentanyl) substitutes it with a partial opioid agonist. If an individual uses the commonly prescribed drug Suboxone, withdrawal symptoms onset within 1-2 hours of the first dose and usually wane within a few hours, and can last as long as a full day.
Precipitated withdrawal related to the use of naltrexone may onset within minutes and last up to two days. However, withdrawal symptoms associated with naloxone are short-lived, lasting only 30 minutes to one hour, on average. In any case, precipitated withdrawal tends to develop rapidly and can lead to very uncomfortable symptoms.
NOTE: This article is for informational purposes only. Just Believe Detox and Just Believe Recovery do not offer Suboxone or methadone as medical detox options.
Opioid Replacement Therapy and Suboxone
Opioid replacement therapy commonly uses either methadone or buprenorphine during detox and maintenance treatment programs. The treatment program, also known as opioid substitution therapy, is based on replacing a full agonist opioid with a long-lasting prescription opioid with less potential for abuse.
Those suffering from an opioid addiction must seek and receive professional treatment to overcome this condition. Suboxone, a prescription withdrawal treatment that consists of the partial agonist opioid buprenorphine and the opioid antagonist naloxone, is one of the most commonly used treatments.
This drug has been effective at helping many recovery addicts break free from opioid dependence, which is the first step in surmounting addiction. Still, no one should ever use withdrawal medications such Suboxone without medical approval and supervision—misuse of these drugs can result in precipitated withdrawal, a condition which, as noted, is highly unpleasant and can provoke relapse.
Symptoms of Opioid Withdrawal
Individuals who have developed a dependence on opioids for a prolonged period, even with a legitimate prescription and taken as directed, will experience withdrawal symptoms upon cessation. However, this problem can be mitigated using opioid replacement therapies such as Suboxone or methadone to relieve withdrawal symptoms.
Also, a person may be weaned from the original opioid using a tapering or weaning schedule until the body is no longer dependent on it. Moreover, if the individual stops using the drug abruptly, they are more likely to encounter uncomfortable withdrawal symptoms.
Early-stage opioid withdrawal symptoms include the following:
- Mood swings
- Depression or anxiety
- Flu-like body aches and pains
- Watery eyes
- Runny nose
- Excessive yawning
- Sweating and chills
Late-stage opioid withdrawal symptoms also may include diarrhea, stomach cramps, nausea, vomiting, and chills.
Depending on the half-life of the specific opioid, withdrawal symptoms can appear within just a few hours and will typically abate after 1-2 weeks. However, precipitated withdrawal symptoms are more intense and are hallmarked by the rapid onset of the symptoms mentioned above.
How Precipitated Withdrawal Is Different Than a Typical Withdrawal
Precipitated withdrawal can manifest when a person with an addiction to full agonist opioids substitutes it with a partial agonist opioid. Although partial agonists attach to the same receptors as full agonists, they do not produce the same effects because they do not incite the same amount of activity at these receptors.
However, a partial agonist can dislodge the full agonist from the receptors, so the effects of the full agonist opioid end promptly. Because the opioid receptor is not stimulated to an equivalent level, there is a net reduction in agonist effects that leads to precipitated withdrawal syndrome.
In other words, when an individual still has full agonist opioid chemicals in their body because they have not yet started the process of withdrawing, introducing a partial agonist such as buprenorphine (as present in Suboxone) can incite a rapid-onset withdrawal.
Opioid withdrawal can swiftly occur when a person discontinues the use of their drug of choice. In comparison, precipitated withdrawal is much more intense, and the individual undergoing it can become very ill and require hospitalization.
Drugs That Can Cause Precipitated Withdrawal
As mentioned, Suboxone is an opioid addiction remedy that includes buprenorphine and naloxone. Naloxone, or Narcan, is an opioid antagonist and anti-overdose drug that displaces full and partial opioid agonists from opioid receptors and attaches to them temporarily.
Naloxone will only become active in Suboxone, however, when the drug is tampered with—a function intended to deter people from misusing it to get high off the buprenorphine. When used as directed, buprenorphine makes contact with opioid receptors and thereby relieves withdrawal symptoms.
As an element of Suboxone, naloxone does not produce precipitated withdrawal in individuals who use it. This condition is actually the result of the buprenorphine displacing a full opioid agonist when the original substance is still present in a person’s body. Nevertheless, naloxone itself can induce precipitated withdrawal by displacing full opioid agonists in the brain.
Indeed, this is an approach used during rapid detox to purge opioids from the body and forces the individual to end their physical drug dependence suddenly. While withdrawal from opioids is usually not significantly risky from a medical standpoint, rapid detox can be extremely painful. Also, Unlike therapy and counseling, it does not address the person’s psycho-emotional reasons for their continued drug use.
Unfortunately, because there are no treatments that address the behavioral changes associated with the rapid withdrawal method, the person is at an increased risk of relapse. And, without physical tolerance, the dose they were used to receiving could induce a life-threatening overdose. For this reason and others, rapid detox programs are not often recommended by well-meaning addiction professionals.
Naltrexone is another medication that can prompt precipitated withdrawal symptoms. This drug is sometimes prescribed to opioid or alcohol addicts after these substances have been eliminated from their bodies. Naltrexone partially blocks the feelings of reward and well-being that these drugs cause, so they do not feel the pleasure they previously anticipated if the person relapses.
However, if naltrexone is delivered before the individual has adequately detoxed from an opioid, the drug will provoke precipitated withdrawal. For naltrexone to be effective, there can be no full or partial opioid agonists in the person’s body, or else this condition will interfere with the drug’s action on the brain.
If an individual does not have a high opioid tolerance, a large dose of buprenorphine can work as a full opioid agonist and produce a high. Conversely, if a person has established a significant tolerance to a more potent opioid (e.g., heroin), the greater the dose of buprenorphine, the more severe precipitated withdrawal will be. Therefore, only small amounts of buprenorphine should be administered to prevent adverse withdrawal symptoms.
When starting a course of Suboxone or another buprenorphine-related therapy, the original drug of abuse should be terminated and the new medication withheld until the individual begins experiencing withdrawal symptoms. The appearance of these symptoms suggests the brain cannot access the opioid as expected, which affects neurochemical behavior.
Detox and Addiction Treatment
Collaboration with medical professionals and addiction specialists during opioid detox can effectively prevent precipitated withdrawal or lessen its impact if it unexpectedly occurs. However, it is crucial to understand that detox is only the first step in addiction recovery. Although necessary, interrupting the body’s dependence on a substance does not sufficiently address addiction as a chronic disease.
After detox, individuals are strongly advised to undergo comprehensive treatment, such as that offered by Just Believe Detox or Just Believe Recovery. These programs include behavioral therapy, counseling, group support, and holistic methods like mindfulness therapy. These services are necessary to help the individual alter his or her behavior and attitudes regarding drugs or alcohol, achieve abstinence, and experience long-lasting, sustainable recovery.