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Drug Withdrawal: Pearls and Pitfalls

Mimics of opioid withdrawal include other intoxication or withdrawal syndromes. As opioid users usually have insight into their addiction, the history is often enough to establish a diagnosis. Several other withdrawal syndromes, specifically ethanol and sedative-hypnotic withdrawal, may appear similar to opioid withdrawal. However, these are much more likely to cause significant tachycardia and hypertension compared to opioid withdrawal. Additionally, these syndromes may produce seizures and/or hyperthermia. Another syndrome that may mimic opioid withdrawal is sympathomimetic intoxication. However, similar to ethanol and sedative-hypnotic withdrawal, this syndrome produces much more severe…

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 COWS Score for Opioid Withdrawal

The Clinical Opiate Withdrawal Score is a well validated tool to help determine if a patient is in opiate withdrawal.

 Managing Opioid Withdrawal in the Emergency Department With Buprenorphine

Emergency departments (EDs) provide acute treatment for patients with opioid use disorder, including opioid overdose and opioid withdrawal, and serve as access portals for the initiation of medication-assisted therapy (also called medication for addiction treatment, or medication for opioid use disorder).

Articles of Interest

Opioid Withdrawal

How we can positively impact the lives of ED patients for years to come – even when they present with simple, run-of-the-mill diagnoses – by thinking outside the box and doing brief screening and interventions for patients with opioid use disorder. She discusses alternative pain control options as well as the use of suboxone to treat opioid withdrawal and opioid addiction.

Concurrent opioid and alcohol withdrawal management

Principles for the treatment of alcohol or opioid withdrawal independently are well-established in clinical practice guidelines and primary literature; however, there is often uncertainty among clinicians about how to manage these withdrawal syndromes when they co-occur.

Getting a Handle on Opioid Withdrawal

Using buprenorphine to treat acute opioid withdrawal requires special care to ensure that sufficient time has elapsed since last use (demonstrated by moderate withdrawal symptoms) because the immediate displacement of existing opioids can precipitate severe withdrawal. Displacement could also generate mistrust in an otherwise effective medication and the health care system more broadly.

Therapeutics: Opioid Use Disorder

Some patients in the emergency department with OUD will be obvious, such as those with an acute opioid overdose requiring the administration of naloxone. Others will be completely unrevealed and may present with severe pain that is otherwise unexplained. Other patients may raise clinical suspicion for OUD based on chronic opioid prescription or documented history of overdose/withdrawal. Patients with a history of other substance use disorders are at higher risk for developing OUD.

Buprenorphine Precipitated Opioid Withdrawal: Tips for Prevention and Management for the Emergency Clinician

Buprenorphine is highly effective for the treatment of OUD but can occasionally cause precipitated opioid withdrawal in some patients. Longer acting opioid use such as methadone and chronic fentanyl use may increase the risk of POW. Microdosing or Macrodosing are alternative dosing options for preventing POW.

Treating Opioid Withdrawal in the ED with Buprenorphine: A Bridge to Recovery

The Emergency Department (ED) is the frontline of the opioid crisis, treating patients with opioid-related infections, opioid withdrawal, and overdose. These encounters can be difficult or even downright confrontational. But that does not have to be the case! With the use of buprenorphine, we can “flip the script” for these encounters, encouraging patient-provider collaboration in the treatment of opioid addiction as medical disease.

Treatment of Opioid Withdrawal with Buprenorphine in the Emergency Department

A 2015 study showed that when patients with opioid use disorder were started on buprenorphine with a behavioral intervention in the ED, they were 80% more likely to remain in treatment at 30 days.