Opioid withdrawal

Timeline

• Heroin and other short-acting opioids
  • 6-24 hours after last dose
  • Peaks 24-48 hours
  • Resolves over 5-10 days
• Methadone and other long-acting opioids
  • 36-48 hours onset
  • Lasts 3-6 weeks

Buprenorphine is the preferred agent for managing opioid withdrawal and is best initiated after symptoms have arisen.

Symptoms

• Anorexia and nausea
• Abdominal pain
• Hot and cold flushes
• Bone, joint and muscle pain
• Insomnia
• Cramps
• Intense craving for opioids

Signs

• Restlessness
• Yawning
• Perspiration
• Rhinorrhoea
• Mydriasis
• Piloerection
• Twitching
• Vomiting
• Diarrhoea

Withdrawal scales

Treatment

• Buprenorphine
  • Should not be started until OOWS of at least 8 or SOWS score of 16-25
  • Relieves symptoms to reduce use of other symptom-relieving medications
  • Can precipitate withdrawal if used heroin in last 12 hours or methadone in last 48 hours
  • 4-6mg dose is a reasonable first dose if showing symptoms of withdrawal
  • Review at 3-4 hours and can give a further 2-4 mg dose if ongoing withdrawal symptoms and no increase in severity
  • Avoid other sedative agents
  • Need daily review and titration of their regime to withdrawal severity
  • Need consideration of ongoing maintenance therapy or complete detoxification
  • Suggested 7 day regime

Other symptomatic treatments

OOWS

SOWS

• Each item is rated 0 to 3 (severe)
• Mild 1-10
• Moderate 11-20
• Severe 21-30

Last Updated on December 11, 2024 by Andrew Crofton