Opioid withdrawal: Difference between revisions

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==Clinical Presentation==
==Clinical Manifestations==

* Onset of symptoms depends on time from last dose and the half-life of the opioid
*Onset of symptoms depends on time from last dose and the half-life of the opioid
** Short-acting opioids ([[heroin]], [[morphine]], [[hydrocodone]], immediate-release [[oxycodone]]): 12 to 16 hours from last dose
** Intermediate-acting opioids ([[slow-release oral morphine]], controlled-release [[hydromorphone]], sustained-release [[oxycodone]]): 17 to 24 hours from last dose
**Short-acting opioids ([[heroin]], [[morphine]], [[hydrocodone]], immediate-release [[oxycodone]]): 12 to 16 hours from last dose
** Long-acting opioids ([[methadone]]): 24 to 48 hours from last dose
**Intermediate-acting opioids ([[slow-release oral morphine]], controlled-release [[hydromorphone]], sustained-release [[oxycodone]]): 17 to 24 hours from last dose
**Long-acting opioids ([[methadone]]): 24 to 48 hours from last dose
* Symptoms progress over time, and vary with the patient, their health status, their frequency, duration, and amount of use, and any concurrent substance use
*Symptoms progress over time, and vary with the patient, their health status, their frequency, duration, and amount of use, and any concurrent substance use
** Within the first 6 to 12 hours: cravings, anxiety, anorexia, irritability, tachypnea, hypertension, sweating, yawning, lacrimation, rhinorrhea, piloerection, tremor, and dilated pupils
** Within 24 to 48 hours: nausea, vomiting, insomnia, tachycardia, abdominal cramps, and involuntary muscle spasms and limb movements
**Within the first 6 to 12 hours: cravings, anxiety, anorexia, irritability, tachypnea, hypertension, sweating, yawning, lacrimation, rhinorrhea, piloerection, tremor, and dilated pupils
**Within 24 to 48 hours: nausea, vomiting, insomnia, tachycardia, abdominal cramps, and involuntary muscle spasms and limb movements
* Persistent symptoms usually resolve over 5 to 7 days
*Persistent symptoms usually resolve over 5 to 7 days
* However, cravings, depression, irritability, and dysphoria may persist for weeks to months
*However, cravings, depression, irritability, and dysphoria may persist for weeks to months

=== Precipitated withdrawal ===

* Occurs when [[buprenorphine]] or another partial opiate agonist is started while there is a full agonist still active


==Diagnosis==
==Diagnosis==

* [[Clinical opioid withdrawal scale]] (COWS)
* [[Subjective opioid withdrawal scale]] (SOWS)
*[[Clinical opioid withdrawal scale]] (COWS)
*[[Subjective opioid withdrawal scale]] (SOWS)


[[Category:Addiction medicine]]
[[Category:Addiction medicine]]

Latest revision as of 19:30, 20 July 2020

Clinical Manifestations

  • Onset of symptoms depends on time from last dose and the half-life of the opioid
  • Symptoms progress over time, and vary with the patient, their health status, their frequency, duration, and amount of use, and any concurrent substance use
    • Within the first 6 to 12 hours: cravings, anxiety, anorexia, irritability, tachypnea, hypertension, sweating, yawning, lacrimation, rhinorrhea, piloerection, tremor, and dilated pupils
    • Within 24 to 48 hours: nausea, vomiting, insomnia, tachycardia, abdominal cramps, and involuntary muscle spasms and limb movements
  • Persistent symptoms usually resolve over 5 to 7 days
  • However, cravings, depression, irritability, and dysphoria may persist for weeks to months

Precipitated withdrawal

  • Occurs when buprenorphine or another partial opiate agonist is started while there is a full agonist still active

Diagnosis