Which opioid analgesic can precipitate withdrawal symptoms if taken only hours after the last dose?

Buprenorphine is a partial agonist at the mu-opioid receptor and has a unique pharmacological profile compared to full agonists. When taken after a recent dose of a full opioid agonist, buprenorphine can precipitate withdrawal symptoms. This occurs because it has a high affinity for the mu-opioid receptor, which allows it to displace other opioids that may still be bound to the receptor but only partially activates the receptor itself. This can lead to a sudden drop in opioid activity if the patient is dependent on a full agonist, hence causing withdrawal symptoms.

The other options listed do not share this specific characteristic. For instance, tramadol is not primarily an opioid and has a lower likelihood of precipitating withdrawal when used after another opioid. Butorphanol and nalbuphine are mixed agonist-antagonists, but they do not have the same high affinity for the mu receptor as buprenorphine, which means they can be used with less risk of triggering withdrawal in a dependent individual. This distinction is critical in pain management practices, particularly when transitioning patients between different types of opioid medication.