Heroin EffectsRespiratorydepression,aspirationpneumonitis,pulmonaryedemaDecreasedmentalstatus,mioticpupilsabsentbowelsoundsHN,Hepatitis,cellulitis,abscesses
Heroin Effects Respiratory depression, aspiration, pneumonitis, pulmonary edema Decreased mental status, miotic pupils, absent bowel sounds HIV, Hepatitis, cellulitis, abscesses
Physical ExamTrack Marks (easilyaccessibleveins)CgBreastveins,dorsalveinpenis,axilla,underfingernails, toes, fingers (to hide use)NasalSeptum(snortingperforation)Cardiacmurmur(endocarditis)Cervicallymphadenopathy(HIVIAIDS)Hepaticenlargement(hepatitis)
Physical Exam Track Marks (easily accessible veins) Breast veins, dorsal vein penis, axilla, under fingernails, toes, fingers (to hide use) Nasal Septum (snorting—perforation) Cardiac murmur (endocarditis) Cervical lymphadenopathy (HIV/AIDS) Hepatic enlargement (hepatitis)
Intoxication HeroinNaloxoneCPureopioid antagonistCg0.1 to 0.4 mg IV (or SQ or IM)CgMayrepeatifneeded
Intoxication Heroin Naloxone Pure opioid antagonist 0.1 to 0.4 mg IV (or SQ or IM) May repeat if needed
OpioidWithdrawalStages of Opiate Yithdrawal SyndromestageFeaturesStageIFear of withdrawal,anxiety,drugcravingUpto8hoursStage llInsomnia,restlessness,anxiety,yawning,stomachcramps,8-24hourslacrimation,rhinorrhea,diaphoresis,mydriasisStage lllVomiting,diarrhea,fever,chills,musclespasms,tremorUpto3daystachycardia,piloerection,hypertension,seizures
Opioid Withdrawal
Opioid WithdrawalHeroineaaaaBuprenorphineMethadone510150Days since last opiate doseSeverity of opioid-withdrawal symptoms after abruptdiscontinuation of equivalent doses of heroin,buprenorphine,andmethadone Peak withdrawal symptomsare most severe afterdiscontinuation of heroin.Such symptoms last longest withmethadonewhichhas a somewhatlaterpeak of severity.Buprenorphinehas milderpeak withdrawal symptoms thandoesmethadone;theduration ofsymptoms is intermediatebetweenthosefor methadone andthoseforheroin.Reproducedwith permission from:Kosten,TR,O'Connor,PGManagementofdrugandalcoholwithdrawal.N.EnglJMed2oo3;348:1786.Copyright@2003MassachusettsMedicalSociety
Opioid Withdrawal