---
title: "Opiate Withdrawal Checklist"
url: https://mghmclean.org/residents/handbk/part2a/opiate.htm
description: "1. Remember, opioid withdrawal is uncomfortable but does not pose a medical threat in otherwise healthy patients."
published: 2026-08-10
updated: 2026-08-10
---

# Opiate Withdrawal Checklist

Published 2026-08-10

PART 3 / CH 24

| Nausea and VomitingNo nausea/vomiting (0)Mild nausea butno retching or vomiting (2)Intermittent nausea withdry heaves (4)Constant nausea andvomiting/dry heaves (6) | RestlessnessNormal activity (0)More than normal activity,With legs up & down,Shifts position occ. (1)Mod. fidgety & restlessshifting position freq. (2)Gross movt. or thrashing (3) |
|---|---|
| **Gooseflesh**None (0)Occ. but not elicited bytouch (1)Prominent, in waves, andelicited by touch (2)Constant over body/arms (3) | **Tremors**None (0)Not visible but felt fingertipto fingertip (1)Mod. when arms extended(2)Severe, even if arms notextended (3) |
| **Diaphoresis**None (0)Barely perceptible, palms (1)Beads on the forehead (2)Drenching over face andchest (3) | **Lacrimation**None (0)Eyes water, tears at cornerof eyes (1)Profuse, wetting the face (2) |

| **Nasal Congestion**None (0)Frequent sniffling (1)Constant sniffling/ waterydischarge (2) | **Yawning**None (0)Frequent (1)Constant/uncontrolled (2) |
|---|---|
| **Change in Temperature**None (0)Reports feeling cold/ handscold & clammy to touch (1)Uncontrolled shivering (2) | **Muscle Aches**None (0)Mild muscle pains (1)Severe muscle painin legs, arms & neck; constant state of contrax (3) |
| **Abdominal Changes**Normal (0)Reports waves of crampypain (1)Reports crampy pain, activebowel sounds, diarrhea (2) | **Grade**< 5 Grade 05 - 8 Grade I9 - 12 Grade II13 - 17 Grade III18 - 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