Opioid Withdrawal


Background
  1. Wide range of symptoms due to abrupt halting or reducing opiate drugs after heavy and prolonged use (> weeks of use)
  2. Opiate drugs: heroin, morphine, codeine, Oxycontin, Dilaudid, methadone, etc.
  3. The incidence of opioid use in North America has been relatively constant over the last decade
  4. However, a trend toward more oral prescription opioid misuse and less intravenous opioid use has been observed
  5. Opioid withdrawal is a common presentation in the emergency department (ED) but it is rarely life-threatening

Pathophysiology

  1. Mechanism
  2. Etiology/Risk Factors
  3. Epidemiology

Diagnostics

  1. History/Symptoms
  2. Physical Exam/Signs
  3. Labs/Tests
  4. Imaging
  5. Other Tests
  6. Differential Diagnosis

Treatment

  1. Initial/Prep/Goals
  2. Medical/Pharmaceutical
  3. Complications of Treatment

Disposition

  1. Duration of withdrawal symptoms dependent on type of opioid being used
  2. Inpatient management in detox program preferable; if severe symptoms may admit to medical service
  3. Mild symptoms in reliable patient: consider outpatient or primary care manager-directed slow taper
  4. Patients already in a treatment program who missed a dose
  5. Keep in mind: unmotivated patients will avoid withdrawal by resuming opioid use as outpatien