Precipated Withdrawal is a rapid and intense onset of withdrawal symptoms initiated by the medication.
Although incidences of patients becoming addicted to Suboxone are low, it is possible and when this happens, a patient may experience withdrawal symptoms similar to those of the original drug addiction for which they were taking the Suboxone in the first place.
In a pharmacological sense, Suboxone is said to have “low intrinsic activity”. What this means is that once the molecule of is attached to a receptor site on the brain, it does not activate or light up that receptor to the same extent most other opioids do, including methadone. You can think of it like a light switch. Where methadone is like turning the light on, Suboxone is like a dimmer switch.
Suboxone is also said to have “high affinity”, meaning it is a very sticky molecule. Once attached to the receptor, it does not like to come off. This is one of the reasons it so long acting. So what does this have to do with withdrawal? Well, if an individual who takes Suboxone for the first time also has recently taken any other opioid, the Suboxone will be forced to compete with that other opioid for the receptor. Because of its “high affinity”, it often wins the battle and throws the other opioid off the receptor site, taking its place instead. This alone does not cause the precipated withdrawal. Once Suboxone is in the receptor its “lower intrinsic activity” does not light up the receptor to the same extent as the opioid that was just removed. This is what causes the withdrawal.
The chances of precipated happening to you is very low if you are completely honest with your physician about the last time you used drugs.
The easiest way to prevent precipitated withdrawal is to be honest with your doctor
To avoid precipitated withdrawal, you must no longer be experiencing the agonist effects of an opioid. One way to gauge this is for the doctor or nurse to observe objective symptoms of withdrawal sufficient to score a minimum on the Clinical Opioid Withdrawal Scale. Higher scores are preferable, that is the more withdrawal that you are in the better.
Since everyone is different, required abstinent times may vary considerably from patient to patient. Only use the time since last use as an estimate to anticipate the onset of withdrawal symptoms.
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