Why Precipitated Withdrawals Happen
- When opioids (like heroin or oxycodone) are used over a period of time, the brain becomes dependent.
- Buprenorphine (the main ingredient in Suboxone) is a patient opioid and has a stronger bond to the same opioid receptors in the brain.
- When Suboxone is taken too early, it pushes the full opioids off the receptors leading to sudden and usually severe withdrawal symptoms.
People with higher levels of physical dependence and those coming off long-acting opioids like methadone may be more likely to experience precipitated withdrawals.
Precipitated Withdrawals From Buprenorphine-Only Medication
The secondary ingredient in Suboxone is Naloxone. Naloxone is not what causes the withdrawals when Suboxone is taken orally. Buprenorphine-only medication will still cause precipitated withdrawals if taken too soon after opioid use.
Precipitated Withdrawals From Injecting Suboxone
With normal use, the naloxone generally doesn’t get absorbed in the bloodstream. But, if Suboxone is injected, the Naloxone is activated and can cause precipitated withdrawals.
Naloxone is the same ingredient in Narcan. The medication acts on the brain’s opioid receptors to knock off and block any opioids that are present. The abrupt removal of opioids from the receptors can also cause precipitated withdrawal symptoms. ⓘ
The Symptoms of Precipitated Withdrawal from Suboxone
The symptoms of taking Suboxone too early after drug use are the same as opioid withdrawal, although usually more immediate and intense, including:
- Anxiety, restlessness or irritability
- Body aches and pains
- Fever and sweating
- Rapid heart rate
- Nausea, vomiting and diarrhea
- Tremors
- Emotional distress
The symptoms and intensity of precipitated withdrawals are different for each person, based on factors like the type, amount and timing of opioids used, the individual’s metabolism and their level of opioid dependence.
What Precipitated Withdrawal Is Like
Precipitated withdrawals are usually described as an intense and distressing experience that is similar to, but worse than regular opioid withdrawal.
"After 20 minutes, my stomach began to hurt and I had to rush to the bathroom. I felt the MOST INTENSE chills and started sweating profusely at the same time. I also felt nauseous. Then, my mind started to slip. It was like a distressing psychedelic trip where I lost touch with reality. Oxycodone and benzos didn’t help. It was only after two hours that the effects gradually subsided and eventually I managed to sleep. I woke up six hours later and felt mostly normal. This was far more horrifying than any opioid withdrawal I've previously experienced."
The worst of it for me was I was having the most intense hot and cold flashes and restless leg syndrome. But, I made it through, and you can too! On day 4, I felt the best I ever did. Subs saved my life.
What To Do If Experiencing Precipitated Withdrawal from Suboxone
1. Seek Help
If you have taken Suboxone without medical supervision and are experiencing symptoms of precipitated withdrawal, going to a Suboxone clinic or hospital will help manage the unpleasantness and prevent relapse.
For example, medications like Ondansetron help manage nausea and vomiting. NSAIDs like ibuprofen help manage pain and fever. Loperamide helps manage diarrhea. Staying hydrated is also important during precipitated withdrawal to prevent complications.
2. Do Not Take More Opioids
Taking more opioids does not help like with normal opioid withdrawal and overdose is much more likely.
Suboxone bonds stronger to the receptors in the brain than other opioids. Opioids taken while in precipitated withdrawal will not be able to attach to the receptors to provide relief like with normal opioid withdrawal. People often take more and more opioids to try to get relief. But, sadly, overdose is more likely than a cure by taking opioids in precipitated withdrawal.
Taking more Suboxone also makes symptoms worse because more opioids get knocked off the receptors.
How Suboxone Impacts Precipitated Withdrawal Symptoms
3. Give Yourself Time
Time is often the only thing that can cure precipitated withdrawals. The good news is that intense precipitated withdrawal symptoms tend to resolve in a matter of hours, not days or weeks like other opioid withdrawals.
See also: How Long Does Withdrawal Last
How To Prevent Precipitated Withdrawals When Taking Suboxone
A healthcare provider considers each patient’s overall health, individual metabolism, drug tolerance, and both the amount and type of substance last used in addition to the general guidelines below to prevent precipitated withdrawals.
Wait For Signs Of Withdrawal
Before starting Suboxone, the patient should be in a state of opioid withdrawal. This helps ensure other opioids are no longer significantly occupying the brain’s opioid receptors.
Exact timing depends on the opioid.
- Short-acting opioids like heroin or prescription painkillers may require 12 to 24 hours from their last dose.
- Longer-acting opioids like methadone might be more like 24 to 48 hours or longer.
Remember, if you hold out initially, the withdrawal symptoms will be helped by Suboxone. But, if you take it too early, only time and comfort medications can help symptoms.
Use The Clinical Opiate Withdrawal Scale (COWS)
Medical professionals use the Clinical Opiate Withdrawal Scale (COWS) to measure the severity of withdrawal symptoms. Patients should not take Suboxone until scoring at least 8-10 on COWS, which indicates mild withdrawal. To better prevent precipitated withdrawal, patients may wait until reaching moderate withdrawal with a score of 13+. ⓘ
Start With A Low Dose
Healthcare providers start with a lower dose of Suboxone and then gradually increase the dose over time, which also helps minimize the risk of precipitated withdrawal. ⓘ
See Suboxone Dose article
Go To a Suboxone Clinic
Precipitated withdrawals rarely happen at a Suboxone clinic. Starting the medication at a clinic means a medical team with specific experience does all the work to monitor vitals and withdrawal symptoms to ensure proper timing. They are also there to support you to stay on track in the first few days and weeks of treatment.
Read more: What is a Suboxone Clinic?
If you’re in Illinois or Texas, here are Symetria’s 5-star Google-rated clinic:
Avoid Precipitated Withdrawals from Suboxone
If the clinics are not near you, visit SAMHSA’s Buprenorphine Treatment Provider tool.