Severe, Nondelirium Agitation as an Underreported Characteristic of Precipitated Fentanyl Withdrawal: A Case Report.

Opioid overdose deaths continue to rise in conjunction with a surge in fentanyl use. Treating withdrawal and initiating recovery may involve rapid initiations of medications for opioid use disorder, such as buprenorphine, but there is a high risk of precipitated withdrawal. We report a case of a 30-year-old man in police custody who experienced precipitated fentanyl withdrawal, and it was refractory to continued buprenorphine escalation. After buprenorphine, he exhibited a particularly dramatic, nondelirium agitation, which we suspect is a common yet underreported characteristic of precipitated withdrawal. Although there was initial concern for delirium secondary to benzodiazepine withdrawal, this was ruled out by mental status examination and verified later by the patient himself. Nondelirium agitation, clarified by mental status testing, ought to be further reported and characterized in future studies of precipitated withdrawal as clinicians and researchers tackle the new challenges of widespread fentanyl use in the United States.