31st January 2024

Presentation

Acute intoxication with opioids causes euphoria and sedative effects. Nausea, vomiting, dizziness, bradycardia, miosis and respiratory depression can also occur, especially if an IV preparation of opioid is used.

Opiate withdrawal can cause fatigue, coryzal symptoms, restlessness and irritability. Tremor, hypertension, tachycardia, nausea and mydriasis may also be seen. Withdrawal from IV heroin typically starts around six hours after injection and peaks at 36 to 48 hours. Scales available to rate opioid withdrawal severity include the Clinical Opiate Withdrawal Scale (COWS) and the Short Opiate Withdrawal Scale (SOWS)

Opioid dependence can be defined by the following ICD-10 criteria:

• Feeling the need/desire to take opioids (prescribed or otherwise)
• An inability to control the level or cessation of opioids
• Withdrawal symptoms  if opioids are not used for a period
• Opioid tolerance development
• Social withdrawal due to opioid use and needing to spend time both recovering from the side effect profile and obtaining more opioids
• Continuing to use opioids despite evidence of their negative effect, e.g., low mood