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Heroin and prescription opioid addiction is a major public health problem in the U.S.
Emergency department (ED) and urgent care healthcare providers often call The Poison Control Center to receive guidance related to the management of opioid withdrawal due to substance abuse. The management of drug withdrawal is complex and healthcare providers are encouraged to develop and use their own institution’s protocols. In the absence of such protocols, The Poison Control Center offers the following guidance.
Therapy for acute opioid withdrawal presenting to the ED or to an urgent care center should be based upon the current goals of therapy, which should be discussed with the patient:
Opioid withdrawal creates great discomfort with dehydration, nausea and vomiting, and over-stimulation.
*A “Clinical Opiate Withdrawal Scale” can be used to quantify a patient’s withdrawal symptoms. One such scale is available at http://www.naabt.org/documents/cows_induction_flow_sheet.pdf.
**Title 42 of the Code of Federal Regulations provides extensive guidance regarding the use of methadone by registered opioid treatment programs. However, it also contains an exemption to these rules for hospitals treating patients with emergent medical needs (21 CFR § 1306.07) allowing physicians “to maintain or detoxify a person as an incidental adjunct to medical or surgical treatment of conditions other than addiction”. Therefore, hospital-based providers do not require specialized training or certification to prescribe methadone and buprenorphine for use in the hospital when patient is being treated for other medical conditions.
When you call the Poison Control Center, we will ask you a series of questions. Here's what we'll need to know so we can help.
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