Abstinence from opiates in an opiate dependent person results in a constellation of signs and symptoms that
are readily apparent to the patient and those to whom he is exposed. The signs and symptoms are usually
several orders of magnitude greater in a precipitated withdrawal. Withdrawal may be precipitatied in several
ways:
- Emergently in a patient who has overdosed and suffering respiratory depression.
- Electively in a patient undergoing rapid opiate detoxification.
- Accidently in a patient who has received a partial antagonist too early, a mixed agonist-antagonist
inadevertantly or an antagonist for any reason.
These signs and symptoms are neurologically based and reflected in the patients mental status, eyes,
skin, musculature and gastrointestinal system.
Since opiates stimulate the pleasure center of the brain, abstinence produces severe displeasure.
This results in a hypervigilant, highly anxious state that produces a demeanor that is offensive.
This frequently leads to less than optimum care. That is, care lacking in compassion, kindness and
understanding. The pupils are dilated. The musculature produces dyskinesia; sudden, jerky, movements.
Hence, opiate withdrawal has been called "kicking the habit." The skin reveals diaphoresis, profound
sweating, and piloerection, hairs standing on end. Often referred to as "gooseflesh." Hyperstimulation
with hypersecretion in the gastrointestinal system results in waxing and waning sharp abdominal pain
with vomiting and diarrhea that can produce fluid and electrolyte problems.
