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opiate_withdrawal

Mx of opiate withdrawal

Mx in ED

  • if withdrawal is due to interruption of normal use, and opioid receptor antagonists such as naltrexone have not been given, and withdrawal is not desirable, then contact AOD team to develop a treatment plan
    • identify withdrawal early and refer to AOD and start Rx early
      • early signs include yawning, diarrhoea, diaphoresis, N/V, dilated pupils, rhinorrhoea, piloerection
      • The primary aim of opioid withdrawal treatment in the ED is to relieve patient distress and reduce harm
      • Ask them what has worked in the past and reassure that their symptoms will be treated
      • Rx options:
        • start or continue methadone
        • start or continue suboxone films
        • sometimes oxycodone can be used while titrating methadone, and for a patient in acute pain
        • once acute withdrawal phase managed, consider long acting injectable buprenorphine
      • On discharge, educate:
        • take home naloxone packs
        • where to seek sterile equipment
        • card for DirectLine
        • offer Addiction Medicine telephone follow up
  • if severe withdrawal reaction causing vomiting and diarrhoea:
    • consider iv fluids to rehydrate and replace GIT fluid losses, sweat and provide usual maintenance fluids
    • monitor electrolytes, glucose, fluid balance
  • adjunctive Rx for Mx of acute withdrawal:
opiate_withdrawal.txt · Last modified: 2022/06/16 03:07 by wh

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