Opioid withdrawal
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
Overview
Opioid withdrawal occurs following the cessation of opioids or the administration of an opioid antagonist following a heavy or prolonged use of opioids. Symptoms of withdrawal from opiates include, but are not limited to, depression, aggression and irritability, leg cramps, abdominal cramps, vomiting, diarrhea, insomnia, and cravings for the drug itself. Depending on the quantity, type, frequency, and duration of opioid use, the physical withdrawal symptoms last for as little as 5 days and as much as 14 days.
Differential Diagnosis
- Sedative-hypnotic withdrawal
- Hallucinogen intoxication
- Stimulant intoxication
- Opioid-induced depressive disorder[1]
Epidemiology and Demographics
Prevalence
The prevalence of opioid withdrawal is 6,000 per 100,000 (60%) of the overall population.[1]
Natural History, Complications and Prognosis
Depending on the quantity, type, frequency, and duration of opioid use, the physical withdrawal symptoms last for as little as 5 days and as much as 14 days. The user, upon returning to the environment where they usually used opiates, can experience environmentally implied physical withdrawal symptoms well-after regaining physical homeostasis - or the termination of the physical withdrawal phase by synthesis of endogenous opioids (endorphins) and upregulation of opioid receptors to the effects of normal levels of endogenous opioids. These implied symptoms are often just as distressing and painful as the initial withdrawal phase.
Detoxification is best conducted in an in patient facility that provides a controlled environment. Patients who are isolated and exposed solely to care givers and other patients in this environment have a better rate of staying clean then those who detox out-patient.
Diagnostic Criteria
DSM-V Diagnostic Criteria for Opioid Withdrawal[1]
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History and Symptoms
Symptoms of withdrawal from opiates include, but are not limited to, depression, aggression and irritability, leg cramps, abdominal cramps, vomiting, diarrhea, insomnia, and cravings for the drug itself.
Additional withdrawal symptoms include, but are not limited to, rhinitis (irritation and inflammation of the nose), lacrimation (tearing), severe fatigue, lack of motivation, moderate to severe and crushing depression, feelings of panic, sensations in the legs (and occasionally arms) causing kicking movements which disrupt sleep, increased heartrate and blood pressure, chills, gooseflesh, headaches, anorexia (lack of appetite), mild or moderate tremors, and other adrenergic symptoms, severe aches and pains in muscles and perceivably bones, and weight loss in severe withdrawal.
References
- ↑ 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.