What is precipitated withdrawal?

Dr. Craig Swainey is the Medical Director of the Coleman Institute for Addiction Medicine and is in recovery himself. Here he discusses what precipitated withdrawal is, what causes it, and how to avoid it.
-Safe, Comfortable Outpatient Detox
The Coleman Institute for Addiction Medicine has been a leading outpatient addiction treatment center since 1998. Our innovative withdrawal management programs, often referred to as The Coleman Method, have helped thousands of people free themselves from addiction to Alcohol, Opioids, and Benzodiazepines. Originally founded in Richmond, Virginia, our network has expanded to cover 14 cities across the US.
-3 - 8 Day Opioid Detoxification Process
For short-acting opiates like oxycodone, most patients complete their detox and begin Naltrexone therapy within 5 days. Longer-acting opiates like Suboxone and Methadone typically take 8 days. Our standard opioid treatment package in Richmond, VA, Wellesley, MA (Boston area) and Willoughby, OH (Cleveland area) includes the detox and 6 months of case management and Naltrexone therapy. As a non-addictive opioid blocker, Naltrexone dramatically reduces cravings so that patients can focus on their recovery. We have a 98% success rate for completing detoxification and starting Naltrexone therapy. During the detox, we work with patients and their families to develop an appropriate aftercare plan. We also offer a convenient, 3-day outpatient alcohol detox and a Rapid Benzodiazepine Detox.
-Caring, Empathetic Environment
Our founder Dr. Peter Coleman understands first-hand the challenges our patients are facing due to his own personal struggle with the disease of addiction. He has been in long term recovery since 1984. Dr. Coleman has dedicated his career to treating addiction patients and creating a team and an environment conducive to long term recovery for his patients.
-For more information, please call us at 888-788-5474 or visit us at www.thecolemaninstitute.com

[@allmightywon4212]

I just botched a 175 mg daily methadone dose transfer to subs, cold turkey. Waited 79 hours and did the first sub. OMG. I'm on the 8th day and starting to feel normal. I even got to the point I was throwing up from too much subs, but still half sick. To top it off, I was offered the job of a lifetime and HAD to interview and start. Thank God I got my legs back the day before I started. After this past week, I'm certain I could make it through Seal training and hell week. No problem, lol.

[@tb80038]

I got off of a pretty bad fent addiction by using the Bernese Method, essentially a micro dose suboxone plan but while also continuing to take fent then each day upping the subs and reducing the fent. It works and has very little discomfort when done correctly.

[@user-mk3qz3et8i]

I felt as weak as a nine month old baby who has salmonella poisoning and the flu.

[@robertruff4391]

That kind of withdraw sucks!!! I ran out of methadone one time and I had two days before going back to the clinic so being the genius I was decided to take half of strip of subutex. How smart was I? I knew what could happen but through all my years of getting high I always beat the system till this time. I started off feeling great. Better than when I took methadone. Then my feet started freezing, then my whole body started freezing, then I was beyond sick. Total withdraw, but it felt worse than regular withdrawal. The next morning I got some pills and I felt better but I had to take 20 10s. Finally I got to go back to the methadone clinic a day later. I couldn't get there fast enough. Anyway Jesus got me through it but thought me a good lesson. I won't ever do that again. Just take your methadone like you suppose to take it.

[@mikesthilaire9807]

I agree with you on this! I was on fetanyl and suboxone only worked for me when i made myself suffer to the point i couldnt take it anymore and had no choice but to do it! Well said and you can tell from listening to you that you are well educated or have 1st hand experience! Start small so the withdrawal isnt so intense! If u can handle it, the only way is up! Gooluck to everyone reading this!

[@CherokeeChief.]

I came back to say I did the Bernese method for 8 days then hopped off for 24 hours no medicine only 1 mg of subutex. Then I took like 4mg and I was in light precipitated withdrawal. It’s nothing like true fully on precipitated withdrawal. Yes it’s been another 7 days and Iv slept really none at all but i made it and I’m only taking subutex. It’s not easy of course but it’s possible. I’m starting to feel better slowly and feel more like myself again. You can do this. Bernese method is the only way to get off of fent on your own terms. The longer you do the method the better chances you have. Best of luck guys you all can do this. I needed someone to tell me they did it before I started. And that’s why I came back. THIS SAVED ME.

[@joshanthony5078]

Actually what stops the precipitated withdrawals when you take subs is actually to take more. I know this sounds crazy but if you take enough subs that it fully attached to your opioid receptors then your fine.

[@2nostromo]

7 year oral morphine user. Very dependent but then I quit completely by using Kratom to treat WDs. I had to play around with the dose but once I figured it out I tapered down over a 6 week period. Kratom removed all the wds.

[@airbornetortilla9489]

I liked, subscribed, and am commenting. I have abused opiates in the past. Then fentanyl came to my town and when I was used my last dose of fentanyl, I waited about 18 hours to wait before I took the 16MG bupronorphine and within an hour I was experiencing hell worse than regular withdrawal. Sweating, heart was pounding out of my chest and I wanted everything the end. I didn't know of microdosing and pretty much just sat out suffered in absolute hellish silence. This video needs to be seen and hear far and wide! I'll spread your channel Doc!

[@ScissorWhit]

I was on 210-240mg of methadone for almost 10 years. I switched to sub a few years ago and my life is infinitely better. However, I decided to shoot a subutex and I was only on 48ish hours of methadone withdrawal. First time I ever experienced precipitated withdrawal. I was yelling uncontrollably and flipping like a fish. Worst feeling ever. But it zapped the methadone right out of my system. I was in precipitated withdrawal for the entire day

[@reneedwards5947]

Wonderful information I just went thru participated withdrawal its horrible wish I could have seen this video very informative thank you

[@natel4545]

Over on the East Coast most treatment centers won’t let you try micro-induction unless you sign a waiver and score higher than 15 on your COWS score. I live outside Philly and 90% of Fetanyl is cut with Xzalazine, or “Tranq.” The issue is docotor’s aren’t properly taking into account that Tranq mimics the effects of opiates, and for a prolonged timeframe (7-14 days dependent on the person). Not only does it cause necrosis, infections, drastically worsened withdrawal, (I’ve seen people take 64mg’s of Phenobarbital and it hardly have a sedative effect on them) etc. It also is killing people left and right as it induces the effects of opiates and causes severe respiratory depression. This may not have effected your patients, but please take into consideration there aren’t standard drug tests for xzalazine (horse tranquilizer) and it is a nasty drug to kick. Stay safe out there people.

[@TheCycle2300]

I know that I always make sure to attempt to pinpoint as much as possible the patient's last time of use as a starting point before giving Suboxone. I agree that microdosing is effective. It's unfortunate that many patients are neglecting this therapy because they were previously started incorrectly or tapered incorrectly, which led them through a terrible withdrawal. I'm an addiction RN (CARN) and just found this video. Nice explanation.

[@marcusbrown6465]

I had an experience with precipitated withdrawal a few days while I was transitioning from methadone to subutex. I can tell from my own experience that it scared the hell out of me and thought I was going to die. I've been on subutex for about 5 days now and am doing much better with it.

[@doctorspockARTS]

Learned about this 6 hours before watching this video. 😢😮😢😢

[@sosalty701]

Is the microdosing method done over the period of several days? How do you find a doctor that does this? My daughter used the Bernese method successfully back in 2020 after several failed attempts at suboxone induction. I did some research and found an article in a medical journal about the increase of fent in the supply, and that it sits in the fat stores. Suboxone releases it and causes precipitated withdrawal. I wish more videos would cover this.

[@derrickforeal]

Kratom really needs to be implemented as a clinical strategy for some.

[@eneslem]

The real reason why naloxone was added was to extend the patent for suboxone. Buprenorphine has so much higher binding affinity for mu compared to naloxone that it realistically naloxone was never going to come close to preventing any sort of abuse of buprenorphine.

[@erictres]

And Naloxone doesn't stop people from shooting or snorting. It was put in so they could keep their patent longer. Just how other medicines become extended release instead of the initial offering of immediate release.

[@MelodyMaker218]

Great info, thanks!