Will I Go Into Precipitated Withdrawal If I Use Suboxone 24 Hours After Fentanyl?

precipitated withdrawal from taking Suboxone after fentanyl

Suboxone is a popular prescription medication that is used to treat opioid withdrawal and dependence. It contains buprenorphine and naloxone and is known for its ability to manage withdrawal symptoms and reduce cravings.

Buprenorphine is a partial opioid agonist that activates opioid receptors but to a lesser degree than other opioids like heroin or fentanyl. This results in fewer withdrawal symptoms without a euphoric high. Naloxone is an opioid antagonist that is used to reverse the symptoms of opioid overdose. It works by displacing opioid molecules from opioid receptors to restore breathing. The naloxone in Suboxone remains inactive unless Suboxone is abused or if someone takes an opioid while on the medication.[1]

Buprenorphine has a high binding affinity to opioid receptors, and it will displace opioid molecules if you take it too soon after an opioid. As a result, Suboxone can have negative and sometimes serious interactions if it is taken too soon after your last dose of fentanyl. Taking Suboxone too soon can result in a concerning condition called precipitated withdrawal. So when can you start taking Suboxone? And will you go into precipitated withdrawal if you use Suboxone 24 hours after fentanyl?

Most of the time, you should wait 12-24 hours after taking fentanyl to start taking Suboxone, but the exact timeframe can vary.

When Can You Start Taking Suboxone After Using Fentanyl?

Generally, doctors and pharmacists recommend that you wait at least 12-24 hours after using opioids before starting Suboxone.[2] The exact timeline depends on what kind of opioid you were using.

Fentanyl is a powerful and potent opioid. Some forms of fentanyl, such as the transdermal patch, are long-acting and can produce effects that last for up to 72 hours. However, other forms of fentanyl, such as illicit fentanyl that is smoked, snorted, or injected, are short-acting. Illicit fentanyl can produce effects that last for 2-3 hours. It has a half-life of 3-7 hours, so it can stay in your body for up to 24 hours.

If you take Suboxone less than 24 hours after your last dose of fentanyl, you are likely to go into precipitated withdrawal. It is best to wait at least 24 hours, more if you have been using the transdermal patch, before starting Suboxone.[3]

Understanding Precipitated Withdrawal

Precipitated withdrawal can occur due to the replacement of full opioid receptor agonists (such as heroin, fentanyl, or morphine) with a partial opioid agonist that binds with stronger affinity (such as buprenorphine). Symptoms of precipitated withdrawal are similar to those of opiate withdrawal but can have a sudden onset and be more severe.

Symptoms of precipitated withdrawal include:

  • Agitation and restlessness
  • Anxiety and panic attacks
  • Muscle aches and pains
  • Nausea and vomiting
  • Diarrhea
  • Dilated pupils
  • Sweating and chills
  • Runny nose and watery eyes
  • Insomnia and difficulty sleeping
  • Increased heart rate and blood pressure
  • Goosebumps or “cold turkey” skin
  • Cravings for opioids
  • Depression and mood swings
  • Fatigue and lack of energy
  • Irritability and agitation

Precipitated withdrawal is considered a medical emergency. If you think you are in precipitated withdrawal, you should seek help from your medical provider immediately.

 

Precipitated Withdrawal

 

Is 12 Hours Long Enough to Wait to Take Suboxone?

Studies have found that the odds of developing severe withdrawal symptoms significantly increased when taking buprenorphine within 24 hours after fentanyl use.[3] As a result, you are likely to go into precipitated withdrawal if you use Suboxone 12 hours after your last dose of fentanyl.

Is 24 Hours Long Enough to Wait to Take Suboxone?

In most cases, it is safe to start taking Suboxone 24 hours after your last dose of fentanyl. However, if you have been using long-acting forms of fentanyl, such as the transdermal patch, it is possible you may experience precipitated withdrawal. In these cases, you should wait at least 48 hours before starting Suboxone.

Regardless of your situation, you should never take Suboxone without a prescription, and you should follow your doctor’s orders as to when you should start taking the medication. Following your prescriber’s instructions is the best way to avoid precipitated withdrawal.

How to Take Suboxone for Fentanyl Withdrawal Safely

If you are considering transitioning from fentanyl to Suboxone but are afraid of going into precipitated withdrawal, there are a few safety precautions to keep in mind:

  1. Consult with your medical provider – Seeking medical guidance is crucial to ensure a safe and smooth transition. Tell your medical provider about when you took your last dose, how much you took, and the extent of your fentanyl use. Being honest with your provider is the best way for them to determine an accurate time to start taking Suboxone.
  2. Follow the prescribed guidelines – Always take Suboxone exactly as prescribed by your healthcare provider to maximize its effectiveness and minimize potential risks. Even if you feel uncomfortable due to withdrawal, do not start taking Suboxone until you are directed to do so.
  3. Be aware of your body’s response – Pay close attention to any changes in your withdrawal symptoms after starting Suboxone. If you experience severe withdrawal symptoms or any other concerning effects, contact your healthcare provider immediately.

If you are detoxing from fentanyl at a medical detox center, the healthcare provider may use the Clinical Opioid Withdrawal Scale (COWS) to determine when you should start taking Suboxone. The COWS looks at several factors, such as pulse rate, sweating, pupil size, body aches, runny nose, anxiety, irritability, tremors, and gastrointestinal upset, scoring these items on a scale based on severity.

When your COWS score is greater than 12 it is usually safe to start taking Suboxone. However, the Substance Abuse and Mental Health Services Administration (SAMHSA) notes that fentanyl may require a higher COWS score and lower initial dosing to prevent precipitated withdrawal.[4]

Find Out if Suboxone Treatment is Right For You

Suboxone may not be right for everyone. If you or a loved one are interested in Suboxone treatment or learning more about your treatment options, please contact our team at Moving Mountains Recovery today. We’re eager to help you start your recovery journey.

References:

  1. National Library of Medicine: Suboxone: Rationale, Science, Misconceptions, Retrieved June 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/
  2. Addiction Science & Clinical Practice: Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: a systematic review, Retrieved June 2023 from https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-021-00244-8
  3. National Library of Medicine: Evidence of Buprenorphine-precipitated Withdrawal in Persons Who Use Fentanyl, Retrieved June 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124721/
  4. Substance Abuse and Mental Health Services Administration (SAMHSA): Buprenorphine Quick Start Guide, Retrieved June 2023 from https://www.samhsa.gov/sites/default/files/quick-start-guide.pdf
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