PART 3 / CH 24
Opiate Withdrawal Checklist
| Nausea and Vomiting No nausea/vomiting (0) Mild nausea but no retching or vomiting (2) Intermittent nausea with dry heaves (4) Constant nausea and vomiting/dry heaves (6) | Restlessness Normal activity (0) More than normal activity, With legs up & down, Shifts position occ. (1) Mod. fidgety & restless shifting position freq. (2) Gross movt. or thrashing (3) |
|---|---|
| Gooseflesh None (0) Occ. but not elicited by touch (1) Prominent, in waves, and elicited by touch (2) Constant over body/arms (3) | Tremors None (0) Not visible but felt fingertip to fingertip (1) Mod. when arms extended(2) Severe, even if arms not extended (3) |
| Diaphoresis None (0) Barely perceptible, palms (1) Beads on the forehead (2) Drenching over face and chest (3) | Lacrimation None (0) Eyes water, tears at corner of eyes (1) Profuse, wetting the face (2) |
| Nasal Congestion None (0) Frequent sniffling (1) Constant sniffling/ watery discharge (2) | Yawning None (0) Frequent (1) Constant/uncontrolled (2) |
|---|---|
| Change in Temperature None (0) Reports feeling cold/ hands cold & clammy to touch (1) Uncontrolled shivering (2) | Muscle Aches None (0) Mild muscle pains (1) Severe muscle pain in legs, arms & neck; constant state of contrax (3) |
| Abdominal Changes Normal (0) Reports waves of crampy pain (1) Reports crampy pain, active bowel sounds, diarrhea (2) | Grade < 5 Grade 0 5 - 8 Grade I 9 - 12 Grade II 13 - 17 Grade III 18 - 31 Grade IV |
source: CIWA - Opiates
Management of opiate withdrawal symptoms (ER/inpatients)
1. Remember, opioid withdrawal is uncomfortable but does not pose a medical threat in otherwise healthy patients.
2. Do not give methadone to patients who will be discharged.
3. Clonidine will provide relief from some autonomic symptoms.
Opiate detoxification (Proctor I protocol)
1. If patient is on methadone maintenance, establish contact with patient’s outpatient methadone clinic; use the usual maintenance schedule.
2. For any signs/symptoms, give methadone 10mg PO x1
3. Methadone 10mg PO q4h PRN signs of withdrawal.
4. Adjuncts for symptom management, e.g.:
· Phenergan 50 mg PO/IM q4h PRN nausea/vomiting
· Dicyclomine 10mg PO/IM q6h PRN cramping