Buprenorphine-precipitated opioid withdrawal is seen in patients physically dependent on opioids who have recently taken full-agonist opioids and are then administered buprenorphine.

Patients with severe withdrawal commonly present to the ED for acute treatment, and reports indicate that this is occurring more frequently among fentanyl users.

Optimal treatment of buprenorphine-precipitated opioid withdrawal is unclear.

Supportive care like clonidine and antiemetics may help in mild cases, but are inadequate in severe ones.

Administration of additional buprenorphine can be limited by the ceiling effect resulting from buprenorphine’s partial agonism.

The efficacy of full agonist opioids (e.g., hydromorphone) to treat buprenorphine-precipitated opioid withdrawal is limited by buprenorphine’s high affinity blockade at mu-opioid receptors.

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