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Suspected Substance Withdrawal in Adolescents — Withdrawal from Other Commonly Misused Substances — Clinical Pathway: Inpatient

Suspected Substance Withdrawal in Adolescents Clinical Pathway — Inpatient

Withdrawal from Other Commonly Misused Substances

  • Consult Poison Control Center for monitoring and symptom management recommendations if concerns for withdrawal symptoms. CHOP clinicians, call 4-2100.
  • Cannabis, nicotine and stimulants are the most commonly reported use-disorders in adolescents with treatment options for withdrawal
  • Xylazine is included because it is commonly associated with illicit opioid use
  • Utilize routine patient monitoring practices
Substance Signs, Symptoms of Withdrawal Resources for Management
THC/Cannabis
  • Irritability, anger, or aggression
  • Nervousness or anxiety
  • Sleep difficulty
  • Decreased appetite, nausea
  • Restlessness
  • Depressed Mood
  • Physical signs and symptoms such as: Abdominal pain, shakiness, sweating/ chills, muscle aches
  • Typically appear 24-72 hrs after abrupt reduction of heavy and prolonged cannabis use
  • Reach peak intensity over the 1st week
  • Largely resolve after 1-2 wks
Consult Psychiatry for agitation plan
Nicotine
  • Irritability, anxiety
  • Nervousness, cravings
  • Difficulty concentrating
  • Sleep difficulty
  • Increased appetite
  • Restlessness
  • Depressed Mood
  • Physical signs and symptoms
    • Decreased heart rate, weight gain
  • Symptoms generally peak in the first 3 days
  • Subside over the next 3-4 wks
  • Cravings for cigarettes may persist for months to yrs
Stimulants
e.g., cocaine, amphetamines, caffeine
  • Depressed mood, low energy, intense exhaustion
  • Agitation and irritability
  • Insomnia
  • Increased appetite
  • Muscle aches
  • Stimulant cravings
  • Auditory and visual hallucinations
  • Suicidal ideation
  • 24 hrs of last use of stimulants, can last for 3-5 days
Consult Psychiatry for agitation plan
Xylazine
  • Irritability
  • Craving
  • Anxiety
  • Dysphoria
  • Tachycardia
  • Hypertension
  • Body aches
  • Worsening withdrawal from opioids or other substance
  • Lowered perceived effectiveness of buprenorphine
Consult Psychiatry for agitation plan
Anticholinergics
e.g., diphenhydramine
  • Mild
    • Dizziness, nausea, vomiting, headache, anxiety
  • Severe (Rare)
    • Urinary urgency, tachycardia, orthostatic hypotension
    • Severe anxiety, or severe insomnia
    • Last 1-3 days- 8 wks
Consult Psychiatry for agitation plan
Other
e.g., PCP, dextromethorphan
Dextromethorphan
  • Dysphoria and intense craving
Consult Psychiatry for agitation plan

 

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