Opioid withdrawal resident survival guide

Resident Survival Guide
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]

Definition

This section provides a short and straight to the point definition of the disease or symptom in one sentence.

Opioid	Peak withdrawal symptoms	Duration of symptoms
Heroin	36-72 hours	7-10 days
Methadone	72-96 hours	14 days
Buprenorphine	36-72 hours	7 days

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

• Common cause 1
• Common cause 2
• Common cause 3
• Common cause 4
• Common cause 5

Management

Shown below is an algorithm summarizing the approach to [[Opioid withdrawal]].

Characterize the symptoms: ❑ Flu like illness ❑ Lacrimation/rhinorrhea ❑ Sneezing ❑ Anorexia ❑ Nausea, vomiting & diarrhea

Examine the patient: ❑ Pupillary dilatation ❑ Gooseflesh (piloerection) ❑ Yawning

Admit the patient

Opioid agonists: ❑ Methadone 20-35 mg daily or ❑ Buprenorphine 4-16 mg daily ❑ Taper by 3% daily over next several days Nonopioid drugs: ❑ Clonidine 0.2 mg every 4 hours tapered after day 3 or ❑ Lofexidine 0.2 mg BD daily, titrated to 1.2 mg BD daily ❑ Treatment duration 10 days for heroin; 14 days for methadone

References

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