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