Contributor: Aaron Lessen MD

Educational Pearls:

Opioid overdoses that are reversed with naloxone (Narcan), a mu-opioid antagonist, can precipitate acute withdrawal in some patients
Treatment of opioid use disorder with buprenorphine can also precipitate withdrawal
Opioid withdrawal symptoms include nausea, vomiting, diarrhea, and agitation
Buprenorphine works as a partial agonist at mu-opioid receptors, which may alleviate withdrawal symptoms

The preferred dose of buprenorphine is 16 mg

Treatment of buprenorphine-induced opioid withdrawal is additional buprenorphine
Adjunctive treatments may be used for other opioid withdrawal symptoms

Nausea with ondansetron
Diarrhea with loperamide
Agitation with hydroxyzine

References

1. Quattlebaum THN, Kiyokawa M, Murata KA. A case of buprenorphine-precipitated withdrawal managed with high-dose buprenorphine. Fam Pract. 2022;39(2):292-294. doi:10.1093/fampra/cmab073

2. Spadaro A, Long B, Koyfman A, Perrone J. Buprenorphine precipitated opioid withdrawal: Prevention and management in the ED setting. Am J Emerg Med. 2022;58:22-26. doi:10.1016/j.ajem.2022.05.013

Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit

Episode 903: Treating Precipitated Opioid Withdrawal

Emergency Medical Minute