Study: When Opioid Withdrawal is Left Untreated, Patients May Leave Before Their Treatment is Complete.

When withdrawal goes untreated, patients leave. A new study shows exactly how often — and what happens next.

By Rehab Malpractice Law | August 2026

A study published in the Substance Use & Addiction Journal on August 14, 2026, put a number on something that families of people in treatment have described for years: when opioid withdrawal is left untreated, patients may leave before their treatment is complete.

The study, by Blaeser and colleagues, looked retrospectively at 332 patients admitted to an acute psychiatric unit between 2019 and 2023 who were at risk for both alcohol and opioid withdrawal simultaneously. Researchers tracked whether patients received buprenorphine, when they received it, and what happened afterward — including whether patients discharged themselves before the clinical team recommended it.

The primary outcome the researchers measured was patient-directed discharge, the more current term for what has historically been called discharge against medical advice.

The findings are striking.

What the data shows

Only 43.7% of patients in the study received buprenorphine. The majority — 187 of 332 patients — received none.

Among patients who did not receive buprenorphine, the patient-directed discharge rate was 15.5 percent. Among patients who received buprenorphine, that rate dropped to 6.9 percent. That is a 55% lower relative rate of self-directed early departure among patients who received the medication.

Timing mattered as much as receipt. Patients who received buprenorphine within the first 24 hours had a patient-directed discharge rate of 5.9 percent. Among patients where initiation was delayed to 24 through 72 hours, that rate nearly doubled to 11.4%.

The difference extended well beyond the hospital stay. Among patients who received buprenorphine, the 90-day inpatient readmission rate was 24.1%. Among patients who received no buprenorphine, it was 46.0%— nearly double.

Why concurrent withdrawal creates a treatment problem

When a patient is experiencing both alcohol and opioid withdrawal at the same time, clinical teams face a difficult prioritization problem. Alcohol withdrawal can produce seizures, delirium tremens, and death, so it appropriately commands immediate attention. But treating alcohol withdrawal while allowing opioid withdrawal to continue undertreated may leave patients experiencing severe physical distress simultaneously.

That distress has a predictable consequence. Patients in significant unmanaged opioid withdrawal — experiencing muscle pain, nausea, anxiety, and profound physical discomfort — may leave the facility before anyone believes it is medically safe for them to do so. Not because they are unwilling to complete treatment, but because the suffering is unbearable.

The chain is not complicated: undertreated opioid withdrawal leads to escalating physical distress, which drives patient-directed discharge, which interrupts treatment, which significantly increases risk after the patient leaves.

ASAM guidance supports stabilizing opioid use disorder with an opioid agonist while simultaneously treating alcohol withdrawal, not waiting until alcohol detoxification is complete before addressing opioid withdrawal. A clinical review on concurrent withdrawal reaches the same conclusion, recommending that opioid withdrawal be addressed concurrently or shortly after initiating alcohol withdrawal treatment and preferring buprenorphine or methadone over clonidine or lofexidine when appropriate.

What this means for families

If a loved one left a treatment facility or hospital before completing treatment, and if opioid withdrawal was not being adequately managed during their stay, this study raises a question families deserve to ask: was the decision to leave truly voluntary, or was it driven by physical suffering that should have been treated?

A patient who leaves because withdrawal symptoms were ignored is not making a free and informed choice. They are responding to pain that evidence-based, guideline-supported care could have addressed.

At Rehab Malpractice Law, we handle cases where treatment facilities fail to provide the standard of care owed to people in withdrawal. Inadequate management of opioid withdrawal, failure to follow ASAM guidance, and patient-directed discharge following untreated suffering are patterns we recognize and investigate.

If your loved one left a Florida treatment facility before completing care, and if you believe inadequate withdrawal management played a role, reach out. The first conversation is free and confidential.

📞 (561) 283-2203 🔗 rehabmalpracticelaw.com

Source: Blaeser S, Colvard MD, Barrett M, Karst A, Brabson JE. "Impact of Time to Buprenorphine Initiation on Patient-Directed Discharge in Concurrent Alcohol and Opioid Withdrawal." Substance Use & Addiction Journal. Published online August 14, 2026. DOI: 10.1177/29767342261467585.

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