Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • maladaptive pattern of opioid use
  • high Addiction Severity Index (ASI) score
  • blunting of pleasurable opioid effects
  • miosis
  • dilated pupils
  • shallow/slow respirations or apnoea
  • needle marks, scars, or necrosis on skin near veins
  • unconsciousness
  • pulse <40 bpm

Other diagnostic factors

  • chronic constipation
  • weight loss
  • nausea/vomiting
  • sedation
  • restless sleep/insomnia
  • memory impairment
  • sneezing
  • yawning
  • abdominal cramps
  • diarrhoea
  • backache/muscle spasms
  • hot and cold flashes
  • hypotension
  • sedation
  • confusion
  • slurred speech
  • aggressive behaviour
  • excess perspiration or lacrimation
  • rhinorrhoea
  • restlessness
  • piloerection
  • tachypnoea
  • hypertension
  • arrhythmias
  • seizures

Risk factors

  • male sex
  • young age
  • hx of mental illness
  • hx of substance abuse
  • long-term opioid therapy
  • FHx of substance abuse

Diagnostic investigations

1st investigations to order

  • urine drug screen
  • gas chromatography-mass spectroscopy (GC-MS)
  • serum electrolytes
  • FBC
  • urea/creatinine
  • LFTs
  • rapid plasma reagent
  • hepatitis serology
  • HIV serology
  • PPD skin test
  • blood cultures
  • beta-hCG
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor

Medical Director

Duke Addictions Program

Department of Psychiatry and Behavioral Sciences

Duke University Medical Center

Durham

NC

Disclosures

AAP is a consultant/member of the advisory board for Cubist Pharma, Biodelivery Sciences (BDSI), Kaleo, Forest Research Institute, and Titan Pharma; is on the speaker’s bureau and received honoraria from Otsuka, Alkermes, Sunovion, and BDSI; and is a shareholder in Ironwood Sciences LLC and Patkar Medical Consultants. AAP's institution has received grant support from National Institutes of Health (NIDA, NIAAA), SAMHSA, AstraZeneca, Bristol-Myers Squibb, Cephalon, Daiichi Sankyo, Envivo Pharma, Forest, J & J, Jazz Pharmaceuticals, Lundbeck, Merck, Organon, Pfizer, Sunovion, Shire, and Titan. AAP holds unpaid positions on the Board of Directors of Southlight Inc, the Board of Advisors of People's Medical Care, the Executive Committee of Triangle Indian American Physicians Society, and also as President of Indo American Psychiatric Association.

Associate Medical Director

The Farley Center at Williamsburg Place

Williamsburg

VA

Affiliate Assistant Professor

Department of Psychiatric Medicine

East Carolina University

Greenville

NC

Disclosures

JCL is a full-time employee at The Farley Center at Williamsburg Place.

Assistant Professor

Department of Psychiatry

University of Missouri - Kansas City

Medical Director

Outpatient Behavioral Health

Truman Medical Centers

Kansas City

MO

Disclosures

DMB declares that he has no competing interests.

Dr Ashwin A. Patkar, Dr Jonathan C. Lee, and Dr Douglas M. Burgess would like to gratefully acknowledge Dr Kamal Bhatia and Dr Srilakshmi Musham, previous contributors to this monograph. KB declares that he has received grant support from National Institutes of Health, Lundbeck Pharmaceuticals, Pfizer, and Titan Pharmaceuticals. SM declares that she has received grant support from Pfizer, Titan Pharmaceuticals, Shire Pharmaceuticals, and the Forest Research Institute.

Peer reviewers VIEW ALL

Assistant Professor

Department of Emergency Medicine

Johns Hopkins University Hospital

Baltimore

MD

Disclosures

AS declares that he has no competing interests.

Professor

Department of Psychiatry and Behavioral Sciences

University of Texas

Health Science Center

Houston

TX

Disclosures

FGM declares that he has no competing interests.

Consultant Psychiatrist and Honorary Senior Lecturer

Institute of Psychiatry

King's College London

London

UK

Disclosures

CK declares that he has no competing interests.

Use of this content is subject to our disclaimer