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What Are Precipitated Withdrawals From Suboxone?

Joseph Sitarik, DO

Medically reviewed by

Joseph Sitarik, DO

January 23, 2019

Suboxone is an opioid antagonist or blocker prescribed by a doctor in early recovery to curb the withdrawal symptoms of opioid addiction. When used properly, Suboxone can provide relief during the difficult stages of detoxification. However, Suboxone can sometimes cause precipitated withdrawals in early recovery.

This severe condition catches many by surprise during the detoxification process and can derail rehabilitation efforts. A better understanding of treatment and preventative measures for this condition can greatly improve the chances of a more comfortable detox for those in recovery.

What Are Precipitated Withdrawals?

Precipitated withdrawals occur when opioid blockers are introduced in the body and purge opioids, such as heroin, from receptors in the brain. Suboxone replaces the opioids causing a sudden onset of withdrawal. Withdrawals are especially severe in the early stages of detox because of the high concentration of residual opioids that must be flushed.

Precipitated withdrawals can be identified by the abrupt and severe onset of:

  • Agitation and anxiety
  • Sweating and chills
  • Yawning and insomnia
  • Diarrhea and dehydration
  • Cramping, nausea, and vomiting
  • Dilated pupils and confusion
  • Watery eyes, runny nose, and increased heart rate
  • Cravings

Being in a mild to moderate withdrawal stage prior to treatment can lessen the likelihood of precipitated withdrawal. This stage typically occurs within 12-24 hours of the last dose of opioids. With a lower concentration of residual opioids in the receptors, opioids can be purged more gradually.

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How Is Suboxone Dosed To Prevent Precipitated Withdrawals?

In addition to introducing Suboxone during the initial withdrawal stage, there are other preventative measures that can be taken. The administering physician will monitor the initial dosing and determine the best dosage. The following methods are used by doctors for dosing to prevent precipitated withdrawals:

  • Determining the level of initial opiate withdrawal by observed symptoms, rather than the last dose of opioids.
  • Matching doses with level of physical dependence and tolerance – 1 mg for low grade addiction, 2 mg for mid grade addiction, and 4 mg+ for higher levels.
  • Evaluating withdrawal symptoms 30 minutes following the first dose of Suboxone. If withdrawal symptoms are still present, a higher dose will be administered. This process is repeated until the correct dose is determined.
  • Further evaluation is necessary 10 days after treatment has started when Suboxone is stabilized in the body. This will also aid in eventual tapering of the drug.

Careful monitoring and proper dosing by a healthcare provider decreases the risk of precipitated withdrawal. It is important to continue communication with your doctor to ensure that the right dose is taken at the right time to prevent discomfort. Follow-up care is crucial as dosing may need to be adjusted to ensure optimal effectiveness.

What If Precipitated Withdrawal Occurs?

Understanding the symptoms and treatment for precipitated withdrawal can help those in treatment find relief. When experiencing precipitated withdrawals, there are a few important things to remember:

  • Opiate use will not counteract the effects of precipitated withdrawals from Suboxone
  • An open line of communication with the monitoring healthcare provider is key to treating symptoms as they occur
  • Precipitated withdrawals are usually short-term, lasting an average of a few hours
  • The length and severity of withdrawals vary from person to person

In the beginning stages of treatment, monitoring the effects of Suboxone is necessary to counteract adverse effects. Raising or lowering the dosage can have adverse effects if done without medical guidance. If Suboxone treatment is reestablished after relapse, the dosage should be reevaluated to ensure a safe transition.

The fear of severe discomfort during detoxification often weighs heavily on the minds of those entering many rehabilitation facilities. When precipitated withdrawal is experienced by someone in recovery, it may negatively affect the rehabilitation process.

The discomfort of precipitated withdrawals is a stark contrast to the euphoria experienced with opioids and may be discouraging to those seeking treatment. Preventative measures, or treating the symptoms as they occur, can greatly boost the chance of success in rehabilitation following precipitated withdrawal.

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If you or a loved one has a concern about precipitated withdrawal, we are here to answer any questions you may have. The caring staff at can provide information about treatment options for opiate dependence, as well as resources for rehabilitation centers in your area. Contact us today.

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