Suboxone – Understanding Precipitated Withdrawal

Opiate withdrawal symptoms normally strengthen gradually over a period of hours or days, but in precipitated withdrawal, a medication can cause the emergence of full strength – agonizing - opiate withdrawal symptoms almost instantly.

Nobody would ever want to experience precipitated withdrawal, so it’s important to understand the 2 ways that Suboxone can lead to it and so learn how to avoid it for sure.

Once you go into precipitated withdrawal after using Suboxone incorrectly, it is very difficult to reverse it. In a normal situation, opiate withdrawal symptoms can be eliminated through the ingestion of an opiate – this will not work for Suboxone caused precipitated withdrawal!

The 2 ways that Suboxone can lead to precipitated withdrawal are:

1. Taking Suboxone Too Soon for the First Time

Buprenorphine (the active ingredient in Suboxone) has higher affinity for the opiate receptors in the brain than opiates of abuse (like heroin or OxyContin, for example).

What this means is – if you are on an opiate drug and you take Suboxone, the buprenorphine in Suboxone will flood the brain, kick out the opiates from the opiate receptors and then fill and block these opiate receptors.

Buprenorphine only partially activates the opiate receptor, unlike regular opiates which fully activate this receptor, so when these receptors are suddenly filled with buprenorphine instead of the opiate they were filled with only moments before – the net result is a sudden and dramatic loss of activation of these opiate receptors. And it is when these opiate receptors do not get sufficiently activated that we experience opiate withdrawal symptoms.

It is for this reason that you must wait until you are experiencing opiate withdrawal symptoms before you can take your first dose of Suboxone. Once you are experiencing opiate withdrawal symptoms, many of your opiate receptors in the brain are already insufficiently activated, and taking Suboxone serves to increase this activation, thus reducing the discomfort you feel.

2. Injecting Suboxone

Suboxone contains 2 active ingredients, buprenorphine and naloxone.

• If Suboxone is taken as directed, sublingually (under the tongue) then the naloxone is not well absorbed and has little or no effect.
• If Suboxone is injected, the naloxone in the medication floods the brain.

Naloxone, like buprenorphine, also has a very high affinity for opiate receptors and it will also ‘kick out’ any opiates from opiate receptors and fill these receptors itself. Unlike buprenorphine, however, naloxone will not partially activate these receptors, it will fully de-activate them – resulting in a sudden complete loss of opiate receptor activation and an immediate entry into a full state of opiate withdrawal.

Naloxone is added to the Suboxone formulation to limit the medication’s abuse potential.

Take Suboxone as Directed

If you follow your doctor’s instructions, wait until you are in opiate withdrawal prior to taking your first dose and never attempt to abuse this medication, you do not have to worry about precipitated withdrawal.

It is your own best interest to follow your doctor's instructions!