Handling Withdrawal Symptoms Before Treatment

MastHead Outline
July 3, 2020

Before someone can begin outpatient medication-assisted treatment with Suboxone® or buprenorphine and naloxone, medical providers will require the patient to cease their substance use at least 24 hours before their first appointment in order to induce early stages of withdrawal. While this may appear to be a formidable task, it’s also an essential one that needs to be handled carefully to gauge a patient’s correct dosage with minimal discomfort and margin for error.

Precipitated Withdrawal

If this part of the treatment process is not approached correctly, and early stages of withdrawal aren’t achieved, a patient with higher levels of opioids in their bloodstream can have an instant reaction to the medication. The treatment medication removes the other opioids from the receptors of the brain, but does not activate them to the same degree which can lead to immediate and significant withdrawal symptoms. This condition is known as precipitated withdrawal and can pose complications for patients looking to start MAT.

Preparing for MAT

In many heroin withdrawal stories, people attempt to stop their drug use by going “cold turkey” and enduring several days of very painful symptoms. Often times, people entering MAT have tried this method in the past and are aware of the agony that lies ahead. While many try this method, most will return to drug use because they will often face relapse due to the long term effects of opiates on the brain.

The safest way to begin the first step to treatment is under medical supervision. With experienced and knowledgeable staff, patients will not have to rely on the unscientific assistance of essential oils for opiate withdrawal or other unproven DIY efforts. Working with an experienced treatment provider can help avoid other dangers as well, including mixing medications like Xanax, using illicitly obtained treatment drugs that may not be safe.

When is it Safe to Start?

Medications like buprenorphine and naloxone or Suboxone® will require the body to be in a state of mild to moderate withdrawal before the first dose. A provider will gauge a patient’s score on a Clinical Opiate Withdrawal Scale (or COWS), which is comprised of the eleven most common symptoms related to withdrawal. Once a patient reaches a certain level on this scale, it will be deemed safe to begin treatment.

Someone who is preparing to enter MAT may feel nervous about this process, especially when actively anticipating withdrawal, but it’s a crucial step into the first stages of one day reaching recovery. Though the beginning phases may be uncomfortable at first, communicating with the clinical provider and staff can help move the process along in a safe environment that can ensure that relapse doesn’t occur before the first dose of MAT begins. Ultimately, this method of opioid use disorder treatment has shown to be the most effective with the lowest rate of chronic relapse, making it a worthwhile life-saving decision and journey.