Anyone who takes an opioid medication, even if a doctor prescribes the medication, is at risk of dependence and addiction. Opioid medications are incredibly effective at alleviating pain, but they have a dark side. In 2017, it was estimated that more than 2 million people had an opioid use disorder, and a further 11 million misused opioid drugs.
Opioids included prescription medications such as oxycodone, Vicodin, morphine, and illegal heroin. These drugs are all part of the same class and produce similar effects on the brain and human body. They relieve pain and also flood the body with dopamine and an intense euphoric high that is very addictive, The more someone takes these drugs, the more the brain begins to adapt to having them circulating through the neural pathways and throughout the body. Using the drugs frequently increases tolerance levels, meaning users will need to take more of the drug to get the same desired effect.
Addiction to drugs or alcohol is a chronic, lifelong condition that requires a multidisciplinary approach to treatment. A combination of behavioral therapy, counseling, and medication comprises the majority of treatment plans for those in recovery. One way to treat opioid addiction is with the use of opioid replacement medications, called MAT, or medically-assisted treatment. In most cases, MAT is a useful approach for helping people in recovery for addiction avoid withdrawal symptoms, decrease cravings, and reduce the risk of relapse. But misusing these medications can cause a distressing condition called precipitated withdrawal.
What is precipitated withdrawal?
The prescription medications Suboxone, Subutex, and Naltrexone are effective at helping people in recovery for opioid addiction transition to sober living. The drugs Subutex and Suboxone are made with the substance buprenorphine, a drug that activates the brain’s opioid receptors. Buprenorphine is intended to reduce withdrawal symptoms, and help patients achieve and maintain sobriety from opioid drugs. The medicine Naltrexone does not activate opioid receptors, but it blocks them instead.
Precipitated withdrawal happens when someone takes one of these medications before they adequately detox from the opioid drugs they are addicted to. Taking these medications too early in the recovery process can cause sudden and severe withdrawal symptoms to occur.
Withdrawal symptoms are part and parcel to the recovery process in drug and alcohol addiction treatment. Withdrawal symptoms vary from person to person, and they will be different for every drug. The withdrawal symptoms that occur in opioid addiction are incredibly intense and painful, but typically not fatal. However, in precipitated withdrawal, these symptoms are much worse. Precipitated withdrawal can include excessive vomiting and diarrhea, intense sweating, and other severe side effects. These intense symptoms can cause health problems and might send someone to the hospital. Dehydration and electrolyte imbalance are a real risk with precipitated withdrawals. Getting treatment from a team of experienced drug abuse counselors and doctors is critical for helping patients avoid issues like precipitated withdrawal.
Why does precipitated withdrawal happen?
Withdrawal symptoms are an inevitable part of the recovery process, and they occur naturally once someone quits or cuts back on a substance. But precipitated withdrawals can be artificially induced when someone starts a MAT plan without properly detoxing from opioids. To avoid precipitated withdrawals, patients should have enough time between their last dose of opioids or heroin before they start a medication like Naltrexone or Suboxone.
Regular opioid withdrawals typically happen over several days to weeks as the brain and body rid themselves of toxic drugs. Detox and withdrawal is the process the body goes through to cleanse itself and return to a state of natural equilibrium and reduced tolerance for substances. But if misused, a drug like Suboxone or Buprenorphine can speed up the withdrawal process, and cause the symptoms to be more severe than usual.
How do precipitated withdrawals occur?
Popular opioid replacement drugs like Suboxone will bind to the brain’s opioid receptors. In opiate addiction, these receptors are fully activated, and this is what causes the effects of the drugs to take place. With replacement opioid drugs, receptors are activated, just not as strongly. So, these drugs do not produce the same, intense euphoria that medicines like Vicodin or illegal drugs like heroin produce. The reason prescriptions like Suboxone are used is to reduce typical withdrawal symptoms and stop cravings for opioids.
Unlike Suboxone, Subutex, and Buprenorphine, Naltrexone can also cause precipitated withdrawals, although the mechanisms it uses to generate this condition differ slightly. Naltrexone is similar to buprenorphine in that it alleviates cravings for drugs and also blocks the high someone gets when they take an opioid. But Naltrexone does not reduce withdrawal symptoms like buprenorphine. However, starting Naltrexone too soon can also trigger precipitated withdrawals. Another cause of precipitated withdrawals is when someone switches from Buprenorphine to Naltrexone.
What are the symptoms of precipitated withdrawals?
The symptoms of precipitated withdrawal can make someone incredibly sick. These symptoms are far more intense and severe than the symptoms seen with regular opioid withdrawals. In precipitated withdrawal, the symptoms are similar to those seen in regular opioid withdrawal but are far more pronounced. The most common symptoms of precipitated withdrawal include:
All withdrawal and detox timelines will be different for each patient, and the same applies to cases of precipitated withdrawals. An individual’s overall health, metabolism, and the duration and severity of their opioid addiction can all influence the timeline and severity of precipitated withdrawals.
How dangerous are precipitated withdrawals?
Precipitated withdrawals are rarely fatal, but patients will usually need to be hospitalized. In some cases, they may be placed in an intensive care unit. The most dangerous condition that can occur in precipitated withdrawals is dehydration. Once hospitalized, patients will usually be given IV fluids and monitored for any more serious health threats, while the condition runs its course. It’s also possible for doctors to administer continuous microdoses of buprenorphine or Suboxone. Sometimes, this is enough to override the precipitated withdrawal symptoms and lessen their severity.
Individuals with pre-existing health issues or conditions are at increased risk of experiencing severe complications from precipitated withdrawal. Since anxiety and extreme agitation are common symptoms in precipitated withdrawal, some patients may need to be sedated or put under general anesthesia while the condition passes. Anti-nausea medications are also given to patients experiencing precipitated withdrawals.
What’s the best way to prevent precipitated withdrawals from occurring?
Time is a critical element for preventing precipitated withdrawals. People who are stating a MAT plan with Suboxone or Naltrexone should be closely monitored for a period before starting their medication. The type of opioid someone is addicted to will also determine how long a patient must wait before starting a replacement medication.
Receiving medication-assisted treatment and counseling from a team of experienced doctors and clinicians is one of the most effective ways to prevent precipitated withdrawals. If you or a loved one are struggling with addiction to opioids, Mission Harbor can help. Please contact Mission Harbor Behavioral Health today to learn more about our detox and rehab programs for opioid and heroin addiction.
The facilities at Mission Harbor are staffed with trained experts to best assist patients with their mental health issues. We are capable of dealing with any and all cases with a licensed staff, equipment, and approved techniques. Our mission is to help those who want to help themselves, and we support your decision in seeking help.
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