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 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. 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.

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.

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.

Differential Diagnosis

Other withdrawal disorders

Sedative-hypnotic withdrawal

Other substance intoxication

Hallucinogen intoxication
Stimulant intoxication

Other opioid-induced disorders

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]

Diagnostic Criteria

DSM-V Diagnostic Criteria for Opioid Withdrawal^[1]

“

A.Presence of either of the following;

1.Cessation of (or reduction in) opioid use that has been heavy and prolonged (i.e.,several weeks or longer).
2.Administration of an opioid antagonist after a period of opioid use.

AND

B.Three (or more) of the following developing within minutes to several days after Criterion A:

1.Dysphoric mood.
2.Nausea or vomiting.
3.Muscle aches.
4.Lacrimation or rhinorrhea.
5.Pupillary dilation, piloerection, or sweating.
6.Diarrhea.
7.Yawning.
8.Fever.
9.Insomnia.

AND

C.The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

D.The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from

another substance.

”