{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T03:17:51Z","timestamp":1774322271427,"version":"3.50.1"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,6,26]],"date-time":"2021-06-26T00:00:00Z","timestamp":1624665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Buprenorphine\u2013naloxone has a very high affinity for the mu-receptor and can cause precipitated opioid withdrawal, typically more severe than withdrawal that occurs naturally, when administered while a full mu-opioid receptor agonist remains in a person\u2019s system. To avoid precipitated withdrawal, one needs to be in mild to moderate opioid withdrawal at the time of buprenorphine-naloxone induction. Recently, there have been reported cases of precipitated withdrawal occurring in patients taking fentanyl knowingly or unknowingly, despite them being in adequate opioid withdrawal at the time of induction. When this occurs, the current recommendation is to provide 2 mg of buprenorphine\u2013naloxone every 1\u20132 hours.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Describe a case of successful management of buprenorphine-precipitated withdrawal with escalation of the dose of buprenorphine and highlight implications for future management.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We present a case of a patient with a history of opioid use disorder who was in moderate opioid withdrawal at the time of buprenorphine\u2013naloxone induction and experienced precipitated withdrawal after buprenorphine\u2013naloxone administration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>High-dose buprenorphine\u2013naloxone was given to the patient and precipitated withdrawal subsided after receiving a total of 20 mg. On the next day, the patient had no symptoms of opioid withdrawal and is currently maintained on 16 mg\/day.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>With the rising prevalence of fentanyl-laced drugs, increased instances of precipitated withdrawal are likely to be encountered. In cases of precipitated withdrawal, giving a high dose of buprenorphine\u2013naloxone rapidly is safe and will allow rapid reversal of withdrawal symptoms.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/fampra\/cmab073","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T11:49:02Z","timestamp":1623239342000},"page":"292-294","source":"Crossref","is-referenced-by-count":20,"title":["A case of buprenorphine-precipitated withdrawal managed with high-dose buprenorphine"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8468-0415","authenticated-orcid":false,"given":"Thomas H N","family":"Quattlebaum","sequence":"first","affiliation":[{"name":"Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9170-414X","authenticated-orcid":false,"given":"Miki","family":"Kiyokawa","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, HI, USA"},{"name":"Department of Psychiatry, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kayla A","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,6,26]]},"reference":[{"key":"2022032512391484100_CIT0001","author":"Corallo","year":"2020"},{"key":"2022032512391484100_CIT0002","volume-title":"Highlights of Prescribing Information, Suboxone","author":"United States Food and Drug Administration","year":"2016"},{"issue":"5","key":"2022032512391484100_CIT0003","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/bja\/ael051","article-title":"Buprenorphine induces ceiling in respiratory depression but not in analgesia","volume":"96","author":"Dahan","year":"2006","journal-title":"Br J Anaesth"},{"issue":"1","key":"2022032512391484100_CIT0004","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jsat.2010.04.001","article-title":"Factors associated with complicated buprenorphine inductions","volume":"39","author":"Whitley","year":"2010","journal-title":"J Subst Abuse Treat"},{"issue":"2","key":"2022032512391484100_CIT0005","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1080\/02791072.2003.10400007","article-title":"The Clinical Opiate Withdrawal Scale (COWS)","volume":"35","author":"Wesson","year":"2003","journal-title":"J Psychoactive Drugs"},{"key":"2022032512391484100_CIT0006","first-page":"282","article-title":"The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies","volume-title":"Transl Psychiatry","author":"Han","year":"2019"},{"issue":"3","key":"2022032512391484100_CIT0007","doi-asserted-by":"crossref","first-page":"E73","DOI":"10.1503\/cmaj.74018","article-title":"Buprenorphine\u2013naloxone \u201cmicrodosing\u201d: an alternative induction approach for the treatment of opioid use disorder in the wake of North America\u2019s increasingly potent illicit drug market","volume":"192","author":"Randhawa","year":"2020","journal-title":"CMAJ"},{"key":"2022032512391484100_CIT0008","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1111\/dar.13228","article-title":"Managing opioid withdrawal precipitated by buprenorphine with buprenorphine","volume":"40","author":"Oakley","year":"2021","journal-title":"Drug Alcohol Rev"},{"key":"2022032512391484100_CIT0009","doi-asserted-by":"crossref","first-page":"S141","DOI":"10.3122\/jabfm.2021.S1.200236","article-title":"Buprenorphine microdose induction for the management of prescription opioid dependence","volume":"34","author":"Robbins","year":"2021","journal-title":"J Am Board Fam Med"},{"issue":"2","key":"2022032512391484100_CIT0010","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1007\/s11606-008-0866-8","article-title":"Home buprenorphine\/naloxone induction in primary care","volume":"24","author":"Lee","year":"2009","journal-title":"J Gen Intern Med"},{"key":"2022032512391484100_CIT0011"},{"issue":"5","key":"2022032512391484100_CIT0012","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.jpainsymman.2013.03.001","article-title":"Buprenorphine","volume":"45","author":"Foster","year":"2013","journal-title":"J Pain Symptom Manage"},{"key":"2022032512391484100_CIT0013","volume-title":"Fentanyl Drug Facts","author":"National Institute on Drug Abuse","year":"2019"},{"issue":"1","key":"2022032512391484100_CIT0014","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1038\/clpt.1980.138","article-title":"Intravenous fentanyl kinetics","volume":"28","author":"McClain","year":"1980","journal-title":"Clin Pharmacol Ther"},{"key":"2022032512391484100_CIT0015"},{"key":"2022032512391484100_CIT0016","volume-title":"Fentanyl, Counterfeit Oxycodone","author":"Hawai\u2019i High Intensity Drug Trafficking Area (HIDTA)","year":"2020"}],"container-title":["Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/39\/2\/292\/43019801\/cmab073.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/fampra\/article-pdf\/39\/2\/292\/43019801\/cmab073.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T18:53:19Z","timestamp":1648234399000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/fampra\/article\/39\/2\/292\/6309967"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,26]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,6,26]]},"published-print":{"date-parts":[[2022,3,24]]}},"URL":"https:\/\/doi.org\/10.1093\/fampra\/cmab073","relation":{},"ISSN":["1460-2229"],"issn-type":[{"value":"1460-2229","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,4,1]]},"published":{"date-parts":[[2021,6,26]]}}}