opiate withdrawal
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Introduction
Also see opioid receptor agonist &/or substance withdrawal
Etiology
- apparently orthopedic surgery is associated with prolonged opioid use[4]
Clinical manifestations
- aggression, hostility, agitation
- yawning, lacrimation (specific to opiate withdrawal)[4]
- insomnia
- myalgia, arthralgia, bone pain
- muscle twitches
- abdominal pain, diarrhea
- diaphoresis
- dysphoria[1]
- mydriasis[4]
- fever, chills, vomiting, tremor, muscle spasms, tachycardia[4]
- piloerection
Differential diagnosis
- binge drinking
- headaches, nausea, memory impairment, elevated blood pressure
- cocaine abuse
- mydriasis, diaphoresis, tachycardia, hypertension, hyperthermia
- < 1% of illicit drug use in young adults[4]
Management
- see opioid dependence
- supportive care: antiemetics, benzodiazepine (not first line)[6]
- long-acting opioid: methadone, buprinorphine (first line)[6]
- clonidine, lofexidine (higher incidence of adverse effects than methadone)[6]
- NSS-2 Bridge device FDA-approved to help reduce the symptoms of opioid withdrawal[2]
- FDA approval recommended for lofexidine (Lucemyra)
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 Clopton J. Medscape. Sep 28, 2016. What Is Kratom? Why Does the DEA Want to Ban It? http://www.medscape.com/viewarticle/869404
- ↑ 2.0 2.1 FDA News Release. Nov 15, 2017 FDA grants marketing authorization of the first device for use in helping to reduce the symptoms of opioid withdrawal. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm585271.htm
Miranda A, Taca A. Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: a multisite, retrospective assessment. Am J Drug Alcohol Abuse. 2018;44(1):56-63. Epub 2017 Mar 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28301217 - ↑ 3.0 3.1 Orciari Herman A, Sadoughi S, Saitz R Nerve Stimulator for Opioid Withdrawal Called into Question. Physician's First Watch, May 3, 2018 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Harper J Questions Raised About Study Of Device To Ease Opioid Withdrawal. Health News from NPR. May 2, 2018 https://www.npr.org/sections/health-shots/2018/05/02/602908208/questions-raised-about-study-of-device-to-ease-opioid-withdrawal - ↑ 4.0 4.1 4.2 4.3 4.4 4.5 NEJM Knowledge+ Psychiatry
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2021
- ↑ 6.0 6.1 6.2 6.3 NEJM Knowledge+ Pain Management and Opioids: Recharge