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opiate withdrawal

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] - questions raised about study skirting FDA rules & ethical norms [3] - FDA approval recommended for lofexidine (Lucemyra)

Related

opioid dependence; chronic opioid use opioid receptor agonist (narcotic)

Specific

neonatal opioid withdrawal syndrome

General

substance withdrawal

References

  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. 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: 28301217
  3. 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. NEJM Knowledge+ Psychiatry
  5. Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2021
  6. NEJM Knowledge+ Pain Management and Opioids: Recharge