Opioid withdrawal: Difference between revisions

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==Clinical Presentation==
 
==Clinical Presentation==
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* Onset of symptoms depends on time from last dose and the half-life of the opioid
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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
 
** Intermediate-acting opioids ([[slow-release oral morphine]], controlled-release [[hydromorphone]], sustained-release [[oxycodone]]): 17 to 24 hours from last dose
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**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
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**Intermediate-acting opioids ([[slow-release oral morphine]], controlled-release [[hydromorphone]], sustained-release [[oxycodone]]): 17 to 24 hours from last dose
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**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
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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
 
** Within 24 to 48 hours: nausea, vomiting, insomnia, tachycardia, abdominal cramps, and involuntary muscle spasms and limb movements
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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
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**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
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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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*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
   
 
==Diagnosis==
 
==Diagnosis==
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* [[Clinical opioid withdrawal scale]] (COWS)
 
* [[Subjective opioid withdrawal scale]] (SOWS)
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*[[Clinical opioid withdrawal scale]] (COWS)
 
*[[Subjective opioid withdrawal scale]] (SOWS)
   
 
[[Category:Addiction medicine]]
 
[[Category:Addiction medicine]]

Revision as of 12:19, 9 July 2020

Clinical Presentation

  • 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