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Source: Doering PL, Li RM. Substance-related disorders I: overview and depressants, stimulants, and hallucinogens. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146064131. Accessed April 12, 2017.
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Addiction characterized by behaviors that include:
Physical dependence: state of adaptation manifested by withdrawal syndrome following:
Withdrawal: development of substance-specific syndrome following cessation or reduced intake of substance that had been used regularly.
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Complications of heroin use include:
Opioids are commonly combined with stimulants (eg, cocaine [speedball]) or alcohol).
Peak respiratory depressant effects occur later and last longer than peak analgesic effects.
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Number of people aged 12 and older who used prescription pain relievers illicitly doubled from 2.6 to 5.2 million from 1999 to 2006.
In 2006, 5.2 million people surveyed used prescription pain relievers illicitly in past month, 17 times number of people who used heroin.
Majority of illicitly used prescription opioids obtained from physicians rather than drug dealers.
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CLINICAL PRESENTATION
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Opioid intoxication:
Euphoria.
Dysphoria.
Apathy.
Sedation.
Attention impairment.
Opioid withdrawal:
Lacrimation.
Rhinorrhea.
Mydriasis.
Piloerection.
Diaphoresis.
Diarrhea.
Yawning.
Fever.
Insomnia.
Muscle aches.
Heroin withdrawal begins within a few hours after stopping drug and reaches peak within 36–72 hours.
Methadone withdrawal may not begin for several days and peak reached at ~72 hours.
Duration of withdrawal ranges from 3–14 days.
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Opioid use and dependence: Urine drug screen.
Withdrawal: Serum electrolytes, complete blood count (CBC)
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DIFFERENTIAL DIAGNOSIS
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Dependence:
Other drug dependence (alcohol, amphetamines)
Underlying psychiatric illness (depression, personality disorder)
Withdrawal:
Other drug withdrawal (alcohol, benzodiazepines, amphetamines, cocaine)
Nausea or vomiting due to other causes (influenza or other viral syndrome)
Delirium suggests withdrawal from another drug (eg, alcohol).
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Cessation of use of drug.
Termination of drug-seeking behaviors.
Return to normal functioning.
Goals of treatment for withdrawal.
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TREATMENT: NONPHARMACOLOGIC THERAPY
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TREATMENT: OPIOID INTOXICATION
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