Opioid WithdrawalMethadonecTapering protocols availableCCANNOTbeusedbyphysicianformaintenance(outsideofalicensedprogram)CgMay use forMAX of 3 days while patientwaits to get into aprogramCgOKtouseforpaincontrolCgOktouseinacutehospital settingfordetoxification for'non opioid addictionadmission (infection, etc)
Opioid Withdrawal Methadone Tapering protocols available CANNOT be used by physician for maintenance (outside of a licensed program) May use for MAX of 3 days while patient waits to get into a program OK to use for pain control OK to use in acute hospital setting for detoxification for ‘non opioid addiction’ admission (infection, etc)
Opioid WithdrawalClonidineCgalpha-2 adrenergic receptor agonist, reducescatecholamine release in the sympatheticnervoussystemandmaydecreasewithdrawal symptoms inpatientstakinglowdosesofopioidsCgUpto1.2mgperdayindivideddosesusedCg0.1 mg doses to 0.2 mg generally
Opioid Withdrawal Clonidine alpha-2 adrenergic receptor agonist, reduces catecholamine release in the sympathetic nervous system and may decrease withdrawal symptoms in patients taking low doses of opioids Up to 1.2 mg per day in divided doses used 0.1 mg doses to 0.2 mg generally
Opioid WithdrawalRapidDetoxificationCgProtocolswithopioidantagonistssuchasnaloxoneplus,clonidinewithorwithoutadjunctivemedicationssuchasbenzodiazepines, antiemetics, and NSAiDsUltrarapidDetoxificationcgGeneral anesthesia while given large dosesof naloxone toinducewithdrawal anddiuretictoremovenarcotics
Opioid Withdrawal Rapid Detoxification Protocols with opioid antagonists such as naloxone plus,clonidine with or without adjunctive medications such as benzodiazepines, antiemetics, and NSAIDs. Ultrarapid Detoxification General anesthesia while given large doses of naloxone to induce withdrawal and diuretic to remove narcotics
Ultrarapid DetoxificationSeriouscomplicationsNo benefit long term from otherdetoxificationprotocolsNot recommended
Ultrarapid Detoxification Serious complications No benefit long term from other detoxification protocols Not recommended
Urine Testing for Drugs of AbusetDrugDuration of detectabilityDrugs causing false positivein urinepreliminary urine screens2 to 3 daysAmphetaminesEphedrine,pseudoephedrinephenylephrine, selegiline,chlorpromazine,trazodonebupropion,desipramine,amantadine,ranitidineCocaine2to3 daysTopical anesthetics containingcocaineMarijuana1to7days(liqhtuse):1monthIbuprofen,naproxyn,dronabinolefavirenz,hemp seed oilwith chronic moderate to heavyuseOpiates1to3daysRifampin,fluoroquinolones,poppyseeds,quinine in tonic water7to 14 daysPhencyclidineKetaminedextromethorphantAdapted from TheMedical Letter 2002;44:71