The YSPH study - led by Hawk, Fiellin and Gail D’Onofrio, an Albert E. These clinicians feared that the removal of those restrictions could lead to more incidences of precipitate withdrawal in patients. “Precipitated withdrawal is an unpleasant experience for the patient and the provider and has the potential to reduce both patient and clinician willingness to initiate treatment with the medication.”Īccording to Fiellin, some symptoms of precipitate withdrawal include acute nausea, vomiting, diarrhea, pain, agitation, anxiety and insomnia.įor this reason, many clinicians were concerned when the Biden administration loosened regulations on buprenorphine, eliminating the requirement for medical providers to obtain waivers before prescribing buprenorphine. “Buprenoprhine is very effective at treating opioid withdrawal, but if given to an individual with opioid use disorder while opioids are still on the mu receptors, the buprenorphine can displace the opioids and cause a significant increase in opioid withdrawal symptoms,” Hawk wrote. However, if buprenorphine is administered too soon after the consumption of fentanyl, this can lead to precipitate withdrawal. Buprenorphine helps treat patients with a substance use disorder by preventing other opioids from occupying these mu receptors. Kathryn Hawk - co-author, emergency physician at YSM and addiction researcher - explained that precipitate withdrawal is a “function of the pharmacology of buprenorphine.” Both buprenorphine and fentanyl bind and activate the mu receptors, which are located in different areas of the brain and work to modulate various physiological functions. Many clinicians and patients are hesitant to prescribe or use the drug, he said, due to the concern that precipitate withdrawal may be common in patients taking this drug who also have used fentanyl, a common and potent synthetic opioid. A study led by Yale School of Public Health and Yale School of Medicine researchers found that precipitate withdrawal in patients using buprenorphine, one of three FDA-approved medications to treat opioid dependence, was less than one percent.Īccording to David Fiellin, an author on the study and professor of general medicine, emergency medicine and public health at YSM, this result came as a surprise.
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