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Opiate Withdrawal

Rob Orman, MD and Ken Starr, MD
00:00
11:30
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Nurses Edition Commentary

Mizuho Spangler, DO, Kathy Garvin, RN, and Lisa Chavez, RN
00:00
03:28

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EM:RAP 2016 October Written Summary 754 KB - PDF

Opiate withdrawal might not be life threatening, but patients often feel like they are going to die. Addiction medicine specialist Ken Starr discusses management strategies for mitigating withdrawal and treating acute withdrawal symptoms.

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Ian M. -

Wondering why you didn't bring up cannabinoids or cannabis? Nabilone can also be helpful for withdrawal symptoms, and there are many people who use cannabis to deal with withdrawal from heroin or other opiates.

Ken S. -

I agree completely. Cannabinoids can be helpful in withdrawal symptom management. I just wanted to present some solutions that most ER docs would feel comfortable in prescribing.

Gregory O. -

Some of these recs don't seem appropriate for use in a patient out of the ED.
I am not going to be following up with these patients and some of these treatments have dangerous and potentially life threatening side effects.
It is great to know the treatments provided in an addiction medicine clinic but I don't think meds such as high dose gabapentin should be prescribed by an EM doc who will not be following the patient.

Ken S. -

Hey Greg. Good comment. I guess if you say these meds are dangerous and have life threatening side effects it would depend on what you're using now. Right?

Gabapentin can be very helpful for withdrawal symptoms in doses around 300mg tid. This is not a high dose and is not at all dangerous. In fact the safety profile is safer than benzos. So, that's why I ask what are you doing now?

Clonidine is well tolerated in acute withdrawal. 0.1mg bid to tid is safe and well tolerated.

Hydroxyzine is also helpful. 50mg tid prn

These drugs are comfortably prescribed by most ER docs.

Drugs I'd like to see ER docs avoid in acute opiate withdrawal are benzos and soma. They have higher abuse and diversion potential.

Thanks for the comment.

Ken Starr

Alicia B. -

Thanks for this piece - I've already referenced it several times and it's helped me with a few patients who came in with refractory and prolonged symptoms. Much appreciated.

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Say Hello to BRUE Full episode audio for MD edition 217:39 min - 303 MB - M4AEM:RAP 2016 October German Edition Deutsche 115:41 min - 159 MB - MP3EM:RAP 2016 October Canadian Edition Canadian 10:10 min - 14 MB - MP3EMRAP 2016 October Résumé en Francais Français 35:33 min - 49 MB - MP3EM:RAP 2016 October Aussie Edition Australian 31:48 min - 44 MB - MP3EM:RAP 2016 October Spanish Edition Español 94:36 min - 130 MB - MP3EM:RAP 2016 October Board Review Answers 187 KB - PDFEM:RAP 2016 October Board Review Questions 292 KB - PDFEM:RAP 2016 October MP3s 257 MB - ZIPEM:RAP 2016 October Written Summary 754 KB - PDF

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