Opiate Withdrawal History and Physical Examination
Opiate withdrawal symptoms peak between 36-72 hours. Symptoms run their course in 5-7 days, though craving continues for some time.
Withdrawal from Heroin
Withdrawal from heroin may begin up to 8 hours after the last use. During the next few hours, the person experiences muscle pain, sneezing, sweating; tearfulness; yawning excessively. At 36 hours after the last use, symptoms are most severe. These symptoms include chills, muscle cramps, flushing, sweating, tachycardia, hypertension, inability to sleep, vomiting & diarrhoea. Symptoms typically continue for about 72 hours & gradually diminish over 5-10 days.
- Aap kia istemal karty
- Akhri bar kab lia hai aap ne
- Abhi dil chahta ke aap dobara se kar lyn? Kitna had tak?
- Gutno ya baqi jorhon mai dard ho raha hai? Baqi jisam or pat’tho mai takleef? Sar dard?
- Pait ma dard waghera? Ulti ya matli to nai arhaii? Pechas ya ihsal ki shikayat?
- Hot and cold flushes?
- Cheenk to naii a rahy baar baar?
- Nend kesi hai? Araam se soe rehty han?
- Koi bechainee, pareshani ki keffyat ya ghussa ata ho?
Physical examinationStart from the hands.
- Inspect the hands and run a hand over the palm. Note any sweating or palmar erythema.
- Note if there is any piloerection if hair visible on the dorsal side of the hands.
- Then check the pulse.
- Inspect the arms for any signs of IV drug abuse.
- Check blood pressure, and then check the temperature.
- Check respiratory rate while checking the above.
- Inspect the face for lacrimation, rhinorrhea and check pupil size for dilation.
- Comment if the patient is shaking or yawning.
- Perform a cardiovascular examination and look for murmurs.
- Examine for the signs of liver failure
- Full blood count, liver and renal function tests.
- Serum urea and electrolytes.
- Hepatitis screen and a test for human immune virus infection. Before performing a test for the immune virus, counselling a patient is important.
- Urine drug screen helps identify other substances in patients with polysubstance abuse. We can detect heroin in the urine for up to 48 hours and methadone for up to 9 days. Urine screen for opioids in patients who are pregnant and those who use low-dose methadone may return false-negative results. Use of loperamide or quinolines may test positively for opioids, too.
- Electrocardiography and chest X-Ray, which may identify endocarditis and pulmonary tuberculosis.
- Echocardiography of the heart if you notice any cardiac murmurs on examination.
- Also, get tests for sexually transmitted diseases—other than human immune virus infection—if the patient has been promiscuous and has not been taking precautions.
- Clonidine, an alpha-2 receptor agonist, which helps reverse the excessive sympathetic manifestations of alcohol withdrawal. Lofexidine is a new, safer alternative to clonidine with less potential for hypotension.
- Buprenorphine, a partial opioid agonist, is useful for rapid detoxification.
- Methadone detoxification
- Self-help materials are always helpful.
- What makes methadone useful for heroin detoxification and long-term maintenance?
- A 40-year-old man who is using IV heroin presented to you with symptoms of endocarditis. What cardiac valves would you look at on the echocardiogram?