Opioid withdrawal: Difference between revisions
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− | ==Clinical |
+ | ==Clinical Manifestations== |
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− | * |
+ | *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 |
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− | ** |
+ | **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 |
+ | **Long-acting opioids ([[methadone]]): 24 to 48 hours from last dose |
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− | * |
+ | *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 |
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− | ** |
+ | **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 |
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− | * |
+ | *Persistent symptoms usually resolve over 5 to 7 days |
− | * |
+ | *However, cravings, depression, irritability, and dysphoria may persist for weeks to months |
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+ | === Precipitated withdrawal === |
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+ | |||
+ | * Occurs when [[buprenorphine]] or another partial opiate agonist is started while there is a full agonist still active |
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==Diagnosis== |
==Diagnosis== |
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− | * |
+ | *[[Clinical opioid withdrawal scale]] (COWS) |
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[[Category:Addiction medicine]] |
[[Category:Addiction medicine]] |
Latest revision as of 15:30, 20 July 2020
Clinical Manifestations
- 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
- 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
- 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