Precipitated Withdrawal: Causes, Symptoms, and Prevention
Precipitated withdrawal is a rapid and intense onset of substance use withdrawal symptoms. Precipitated withdrawal can occur during a detox program using medication-assisted treatment (MAT) instead of allowing the substance to naturally leave the body. Some of the medications addiction specialists use during detox are naltrexone and suboxone (which is made with buprenorphine).
Are you or someone you love experiencing the pain of substance addiction? If you’re worried about seeking recovery assistance because you’ve heard of precipitated withdrawal or you’re simply afraid of the addiction stigma, this is a non-judgment zone in which you can heal for good. Contact Zinnia Health or call us today at (855) 430-9439 to speak to one of our compassionate specialists.
What is Precipitated Withdrawal?
This type of withdrawal, as its name suggests, is precipitated—or hastily brought about—during the initial phases of an addiction treatment program. For instance, someone who is severely physically dependent on (or addicted to) opioids and requires immediate treatment may receive suboxone, a medication for opioid use disorder, during the detox portion of treatment and potentially as an ongoing medication to help the individual refrain from opioid use.
One of suboxone’s main ingredients is buprenorphine. Buprenorphine is an opioid agonist that, once in the body, dukes it out with any already present opioid substances in a war for receptors.
Buprenorphine is stronger than opioids in this sense and gives any opioid substances “the boot.” Once the opioid substance is no longer attached at the brain’s opioid receptors, the buprenorphine swiftly moves in.
This is the point, however, that can induce precipitated withdrawal. In a person suffering from physical opioid dependence, this rapid exit of opiates and replacement with buprenorphine almost immediately instigates opioid withdrawals.
So, you might wonder: Shouldn’t addiction medicine help a person? Isn’t this worse for the addict? Well, the answer is: it depends.
Symptoms of Precipitated Withdrawal
To begin the journey to sobriety, all illicit substances must be removed from the body followed by abstaining from further substance use. MAT therapies are just one way a treatment center might help an addict detox. While medication-assisted treatment is responsible for precipitated withdrawal, MAT therapies are not inherently bad.
Rather, MAT is sometimes a must depending on the specific addiction—such as fentanyl—but it must be used in a highly controlled environment with addiction treatment advisors overseeing the activity to help alleviate precipitated withdrawal dangers.
For instance, the prescribing physician may order a dose of buprenorphine to help someone eliminate heroin from their body. For someone addicted to heroin, the opioid effects of buprenorphine are incredibly mild in comparison—yet buprenorphine is like Rocky Balboa displacing the heroin molecules.
This immediate displacement is where the danger resides: the trade-off of buprenorphine for heroin in this manner can trigger abrupt and severe withdrawal symptoms that must be monitored closely for the person’s safety.
The body can’t adjust to the instant deprivation of opioids, which causes multiple side effects, including:
- Muscle aches
- Body pains
- Fever
- Muscle or stomach cramps
- Profuse sweating
- Inability to sleep
- Pupil dilation
For a long-term addict or someone with substance use disorder who’s severely physically dependent on heroin, they can experience drastic symptoms, such as:
- Depressed moods
- Uncontrollable liquid bowel movements
- Thoughts of suicide
- Racing heartbeat
- Elevated blood pressure
Although buprenorphine is also an opioid, it’s not as strong as heroin. Buprenorphine treatment is meant instead to help ease a person through the withdrawal symptoms associated with rapidly detoxing from significant drug use.
Opioid Receptors and Their Agonists
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.
Heroin is amongst the class of opioids termed full agonists. Other drugs in this class include:
- Morphine
- Methadone
- Codeine
Buprenorphine, while also an opioid, is a partial agonist. So painkilling effects and a euphoric disposition are still induced but to a much lesser degree. Plus, buprenorphine has a ceiling effect—once a certain amount of these molecules are attached to the receptors, the body and brain no longer register the effects, thereby reducing the potential for buprenorphine abuse.
If you or someone you love is battling the challenges of opioid addiction, help is available. Zinnia Health can help you heal for good. Call us at (855) 430-9439 to speak with a compassionate addiction treatment specialist.
How To Stop Precipitated Withdrawal
It’s important that addicted individuals and their loved ones receive education surrounding their expectations of a substance abuse treatment program. Before beginning detox, the opioid’s agonist effects must no longer be present. The Clinical Opioid Withdrawal Scale (COWS) outlines opioid withdrawal symptoms for objective observation prior to beginning treatment.
A trained addiction treatment specialist uses the person’s COWS score to determine when treatment should begin—typically around a score of 5 or 6. COWS looks at the most common opioid withdrawal symptoms to gauge the level of opioid addiction.
The COWS measures these 11 withdrawal symptoms for the previous 30 minutes:
- Resting heart rate
- Level of sweating
- Observable restlessness
- Size of pupils
- Bone, muscle, or joint pains
- Runny nose or watery eyes
- Stomachache, diarrhea, or vomiting
- Visible shakes or tremors
- Yawning
- Anxiety
- Goosebumps
Each withdrawal symptom is scored on a scale of 0 to 4, with 0 meaning “not observed” and 4 meaning significantly occurring. The highest score is 44, and a score of less than 10 is preferred before beginning detox or other treatment.
Concerns Regarding MAT Therapies
Suboxone is often prescribed for opioid addicts to help remove the substance from the person’s body prior to substance abuse rehab. Suboxone is a combination of buprenorphine and naloxone and together, these substances are a powerful tool to help reduce an addict’s compulsive behaviors and keep cravings to a minimum.
The problem with this treatment is the strength of Suboxone. It’s good at its job when used appropriately under the care of a treatment specialist—but for someone who’s still physically or psychologically dependent on dangerous drugs like heroin, suboxone’s strength is concerning.
Suboxone can induce precipitated withdrawal, so a treatment specialist’s best judgment and the use of COWS scoring can help the care team discern when suboxone treatment can begin.
Heal for Good with Zinnia Health
Breaking the cycle of addiction requires detoxing to remove the illicit substances from the body so it can begin to heal. But detox for opioid addiction must be carried out under the care of a compassionate substance abuse treatment team.
If you or a loved one needs help navigating the road to sobriety after opioid addiction, Zinnia Health can help. Call us at (855) 430-9439 to learn more about our uniquely tailored treatment plans.