Opioid withdrawal On the Web
American Roentgen Ray Society Images of Opioid withdrawal
Opioid withdrawal occurs due to 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.
- Sedative-hypnotic withdrawal
- Hallucinogen intoxication
- Stimulant intoxication
- Opioid-induced depressive disorder
Epidemiology and Demographics
The prevalence of opioid withdrawal is 6,000 per 100,000 (60%) of the overall population.
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.
DSM-V Diagnostic Criteria for Opioid Withdrawal
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.
Differentiating opioid withdrawal from other diseases and conditions
|Disease||Prominent clinical features||Investigations|
|Hyperthyroidism||The main symptoms include:|
|Essential hypertension||Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below:||JNC 7 recommends the following routine laboratory tests before initiation of therapy for hypertension:|
|Generalized anxiety disorder||According to DSM V, the following criteria should be present to fit the diagnosis of generalized anxiety disorder:
|Menopause||The perimenopausal symptoms are caused by an overall drop, as well as dramatic but erratic fluctuations, in the levels of estrogens, progestin, and testosterone. Some of these symptoms such as formication etc may be associated with the hormone withdrawal process.
|Opioid withdrawal disorder||According to DSM V, the following criteria should be present to fit the diagnosis of opioid withdrawal:
|Pheochromocytoma||The hallmark symptoms of a pheochromocytoma are those of sympathetic nervous system hyperactivity, symptoms usually subside in less than one hour and they may include:
Please note that not all patients with pheochromocytoma experience all classical symptoms.
|Diagnostic lab findings associated with pheochromocytoma include:|