Opioid withdrawal (psychoactive substance use)

Question 1

Who does opioid withdrawal affect?

Answer 1

-Those withdrawing from opioids, commonly seen in morphine, heroin, codeine, methadone, oxycontin and hydromorphone withdrawal
-Chronic use can lead to incapacitating dependence
-Most commonly abused group of drugs, use is increasing

Question 2

What causes opioid withdrawal?

Answer 2

-Occurs when a dependent user suddenly reduces / stops taking opioids
-Can also occur when an antidote is given eg buprenorphine / naloxone / naltrexone

Question 3

How does opioid withdrawal present?

Answer 3

-Lacrimation / rhinorrhoea
-Piloerection
-Myalgia
-Diarrhoea
-N+V
-Pupillary dilation, photophobia
-Insomnia
-Autonomic hyperactivity (tachypnoea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia)
-Yawning

Question 4

How would you investigate a patient with opioid withdrawal?

Answer 4

-Urine toxicology (+ve for 12-36h after use)
-ECG
-FBC
-Blood alcohol level
-Clinical Opioid Withdrawal Scale (COWS)

Question 5

What treatment would you consider in someone with opioid withdrawal?

Answer 5

-Long-term opioid replacement with methadone / buprenorphine
-Loperamide for diarrhoea
-Promethazine for N+V