opioid withdraw

  • Sx: rhinorrhea, lacrimation, diarrhea, and body aches. Mydriasis, yawning, abdominal cramping, piloerection, and elevated pulse and blood pressure
  • Management: Withdrawal can be managed with methadone or nonopioid medications such as clonidine. Methadone is preferred over buprenorphine (also an opioid agonist) due potential worsening of withdrawal from buprenorphine (from its partial opioid antagonist effects).

The decision of which agent to select is related to the treatment setting; opioid agonist therapy requires high levels of regulation in a supervised program. Because this patient has been discharged from his methadone program and is unwilling to enter a supervised detox setting, opioid agonists (methadone, buprenorphine) for detox would not be advised. Clonidine, an alpha 2 adrenergic agonist, would be the most appropriate choice to reduce this patient's level of autonomic arousal and discomfort. His vital sign abnormalities would be expected to normalize with treatment of his withdrawal symptoms. Common adjunctive treatment includes benzodiazepines, and antiemetics and antidiarrheals for symptomatic relief.