May 2023 Journal Club – Revisiting Precipitated Withdrawal in the Fentanyl Era

Some of you remember the days when precipitated withdrawal (PW) felt mostly theoretical. It was before fentanyl suffused the drug supply. At that time, it generally occurred with methadone to buprenorphine transitions or when the advice to wait for moderate withdrawal was not properly heeded. In the last several years, on-the-ground providers are hearing and seeing more about buprenorphine inductions leading to precipitated withdrawal. This large study reports a remarkably low incidence of precipitated withdrawal and cites it as similar to the pre-fentanyl era. This is perhaps reassuring but also made me wonder –did anxiety bend my risk perception of PW, or is the risk actually this low in my patient population?