Opiate withdrawal

Opiate withdrawal is rarely fatal but is extremely uncomfortable and typically is accompanied by strong cravings.
Withdrawal signs and symptoms: vomiting, diarrhea, body aches, rhinorrhea, thermoderegulation, insomnia, anxiety, dysphoria, gooseflesh, yawning, and pupil dilation.
Treatment can be symptomatic, as with the alpha-2-adrenergic agonist clonidine, or can involve receptor agonist or antagonist activity. Methadone can be used with short- or long-taper protocols. Buprenorphine, a partial opiate agonist can similarly be used. Naltrexone + clonidine has been used effectively in both inpatient and outpatient settings (Ries et al., 2009).

Rakel: Textbook of Family Medicine, 8th ed. Chp. 51 Drug abuse


 TABLE 83-5   -- Dose Equivalence of Opioid Drugs

DRUG	Single-Dose Analgesic Equivalence		Maintenance Dose Equivalence (Total Daily Dose)
	Subcutaneous (mg)	Oral (mg)	Subcutaneous (mg)	Oral (mg)
Morphine	10	60	40	100
Heroin	4	—	16	—
Methadone	10	20	10	20
Buprenorphine	0.3	1 (sublingual tablet)	1	2 (sublingual tablets)
Codeine	120	200	—	600

Modified from An Overview of Opioids and Treatment Approaches. New South Wales Health Department. North Sydney, Australia, 2001.

Consult 藥師: 美沙東1cc=5mg Morphine PO