Opioid Withdrawal ( Symptoms, During, Diagnosis )

 

I. Introduction 

Opioid withdrawal symptoms occur when the users are physically dependent upon opioids reduces or stops opioid use abruptly.

We can use opioid antagonist to counter those symptoms including :
Naloxone, naltrexone or nalmefene, or an opioid partial agonist(buprenorphine). 

Signs and symptoms of opioid withdrawal include drug craving, restlessness, anxiety, diaphoresis, tachycardia, and gastrointestinal distress.

II. Clinical findings 

The signs and symptoms of untreated opioid withdrawal include  :
 Gastrointestinal distress: Nausea/Vomiting, cramps, abdominal cramps, diarrhea 
 Lacrimation, diaphoresis, shivering, piloerection(goosebumps)
 Sympathetic nerve and central nervous system arousal: Mydriasis, mild hypertension, and tachycardia, anxiety and irritability, insomnia, agitation, restless leg syndrome, tremor,
 Other: Yawning, sneezing, anorexia, dizziness, myalgia/arthralgias, and leg cramps

III. Duration 

Generally, the users of opioids take around three weeks consumed daily to be addicted. Withdrawal will only occur in those who have developed tolerance to the opioid.
The time we stop the users from continuing their drugs might result in an uncomfortable way and rarely life-threatening.

IV. Assessment

The question, we should ask the patients including a substance use history, psychiatric assessment and history, mental status examination, medical history and physical examination, laboratory testing, level of care determination, or we can use naloxone if we suspect they have physiologic dependence. 
 Substance use history : 
– We should ask the patients about each substance used, the amount used, frequency, route, duration, and time of last use.
– Prior medication for opioid use disorder or other substance use disorder treatment
 Psychiatric status : 
– Including Suicidality, anxiety, mood, psychotic, and trauma-related disorder, past treatment, and response.
– Lithium levels can markedly with dehydration and must be monitored closely.
– Carbamazepine may increase methadone dosing needs.
 Medical history and physical exam : 
– Patients history of diseases including signs of cardiovascular disease (eg, congestive heart failure, hypertension or hypotension, and arrhythmias)
– History consistent with esophageal varices, blackouts, and falls due to vomiting should be elicited.
– Dehydration resulting from frequent vomiting or severe diarrhea during supervised withdrawal, aggressive hydration may be needed.
– Diabetes can be complicated by poor oral intake during withdrawal
 Laboratory and another testing : 
They include a complete blood count, a comprehensive metabolic profile including electrolytes, calcium and magnesium, glucose, liver and renal function tests, prothrombin time/partial thromboplastin time, HIV, and hepatitis B/C. Electrocardiogram will assess QT/QTc, cardiac rhythm, and evidence of cardiac ischemic. 

V. Diagnosis 

A. Presence one of these below : 
1/. Cessation ( or reduction in ) opioid that has been heavy and prolonged used. 
2/. Administration of an opioid antagonist after a period of opioid use.
B.Three or more points following minutes or several days after Criterion A : 
– Dysphoric mood
-Nausea/Vomiting
-Yawning
-Fever 
-Insomnia
-Muscles arches 
-Pupillary dilation, piloerection, or sweating 
C. The signs or symptoms might cause distress or impairment in social, occupational, or other important areas of functioning. 
D. The signs and symptoms are not better explained than intoxication or withdrawal from another substance.