II. Symptoms
- Classic triad for Opioid Withdrawal
- Piloerection
- Rhinorrhea
- Lacrimation
- Other general symptoms
III. Management: General protocol for cessation of Opioids
- Maintain hydration during cessation
- Opioid Withdrawal is uncomfortable but not life threatening
- Contrast with Alcohol and Benzodiazepine Withdrawal which are potentially life threatening
- Small to moderate chronic daily Opioid use: Stop Opioid cold turkey
- Less than 10 days of daily Opioid or
- Morphine Sulfate (or equivalent dose of other Opioid) <30 mg per day
- Moderate to high chronic daily Opioid use
- Taper by 10% per week up to as fast as 10% daily
- Consider detoxification admission for non-compliant patients
- Methadone protocol
- Buprenorphine protocol
IV. Management: Clonidine
- Mechanism
- Decreases sympathetic CNS stimulation (noradrenergic response)
- Typically used in combination with other agents below (e.g. Gabapentin)
- Dosing
- Clonidine 0.1 mg orally every 8-12 hours for 5 days
-
Clonidine (Catapres) Indications
- Non-life threatening Symptoms and Signs
- Anxiety
- Gastrointestinal symptoms
- Other withdrawal symptoms (Piloerection, yawning, sneezing, Rhinorrhea)
V. Management: Other medications
- Withdrawal and craving symptoms
- Tizanidine 4-8 mg orally every 8 hours
- Baclofen 10 mg orally every 8 hours
- Gabapentin (Neurontin) 300 mg orally every 8 hours
- May be used with Tramadol
- Tramadol taper
- Gastrointestinal symptoms
- Dicyclomine (for abdominal cramping)
- Loperamide (for Diarrhea)
- Psychiatric symptoms
- Hydroxyzine (for agitation)
- Trazodone (for Insomnia)
- Miscellaneous symptoms
- NSAIDs (for myalgias)
VI. Course
- Expect withdrawal symptoms for at least 7 days (up to weeks)
VII. References
- Orman and Starr in Herbert (2016) EM:Rap 16(10): 3
Images: Related links to external sites (from Bing)
Related Studies (from Trip Database) Open in New Window
| Concepts | Mental or Behavioral Dysfunction (T048) |
| ICD10 | F11.3 |
| SnomedCT | 268687009, 192221004, 87132004 |
| DSM4 | 292.0 |
| English | Opioid Withdrawal, Mental and behav dis due to use opioids: withdrawal state, Mental and behavioral disorders due to use of opioids: withdrawal state, Mental and behavioural disorders due to use of opioids: withdrawal state, Opioid withthdrawal state, [X]Mental and behav dis due to use opioids: withdrawal state, [X]Mental and behavioral disorders due to use of opioids: withdrawal state, [X]Mental and behavioural disorders due to use of opioids: withdrawal state, [X]Opioid withthdrawal state, Mental and behavioral disorders due to use of opioids, withdrawal state, Mental and behavioural disorders due to use of opioids, withdrawal state, opioid withdrawal, opioid withdrawal (diagnosis), narcotic withdrawal, withdrawal narcotic, narcotics withdrawal, [X] Mental and behavioural disorders due to use of opioids: withdrawal state (& [cold turkey, opiate withdrawal]) (disorder), [X] Mental and behavioural disorders due to use of opioids: withdrawal state (& [cold turkey, opiate withdrawal]), [X]Mental and behavioral disorders due to use of opioids: withdrawal state (disorder), [X] Mental and behavioral disorders due to use of opioids: withdrawal state (& [cold turkey, opiate withdrawal]), [X]Cold turkey, opiate withdrawal, Opioid withdrawal, Narcotic withdrawal, Opioid withdrawal (disorder), opioids; withdrawal state, withdrawal state; opioids |
| German | Psychische und Verhaltensstoerungen durch Opioide: Entzugssyndrom |
| Spanish | [X]trastornos mentales y del comportamiento debidos al uso de opiáceos: estado de abstinencia, [X]trastornos mentales y del comportamiento debidos al uso de opiáceos: estado de abstinencia (trastorno), abstinencia de narcóticos, abstinencia de opiáceos (trastorno), abstinencia de opiáceos |
| Dutch | onthoudingstoestand; opioïden, opioïden; onthoudingstoestand, Psychische stoornissen en gedragsstoornissen door gebruik van opioïden; Onthoudingstoestand |
