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Psychological Medicine
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Harrison Howarth, Jim Bolton, Gary Bell
Clinical features will depend on the drug used. Opioid misusers often present to general medical services with a disease for which they have increased susceptibility (e.g. infective endocarditis or HIV), or with complications of repeated intravenous injection, such as an abscess. The symptoms of opioid withdrawal are unpleasant but rarely life-threatening (see OPIOID WITHDRAWAL: CLINICAL FEATURES AT A GLANCE). They include: Psychological: anxiety, agitation, fatigue, irritability and insomniaPhysical: runny nose, teary eyes, hot and cold sweats, shivers, yawning, muscle aches and pains, abdominal cramps, nausea, diarrhoea and vomiting
Drug abuse in pregnancy: Marijuana, LSD, cocaine, amphetamines, alcohol, and opiates
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Jacquelyn C. Howitt, Anita Bublik-Anderson
Opioid overdose causes stupor, a decrease in body temperature, flaccid muscles, eventually coma, convulsions, and cardiorespiratory arrest (74). Opioid withdrawal, on the other hand, is marked by dilated pupils, irritability and restlessness, insomnia, anorexia, tachycardia, weakness, depression, nausea, vomiting, stomach and muscular cramps, muscle twitching, “gooseflesh,” chills, hypertension and tachycardia, tearing, rhinorrhea, and yawning. Withdrawal, though distinctly uncomfortable, is usually not life-threatening (3). Opioid abuse in pregnancy has both direct and indirect effects on the fetus. There is a direct opiate effect due to the transplacental passage of opiates, while indirect effects are a result of related maternal malnutrition or infection, and other sequelae of polydrug abuse and high-risk behaviors. For example, heroin addicts have higher rates of infections, including sexually transmitted diseases (75,76); intravenous drug use increases the risk of contracting such diseases as HIV and hepatitis (76). Opiates readily cross the placenta and have been identified in amniotic fluid, umbilical cord blood, neonatal urine, and meconium (76).
Pain management
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
The severity of opioid withdrawal depends on the consumed dose, duration of use, and route of administration.44 The Clinical Opioid Withdrawal Scale and Objective Opioid Withdrawal Scale may be used to assess the severity of withdrawal. Withdrawal onset and duration of opioid withdrawal symptoms depend on the half-life of the opioid. For example, in patients using short-acting opioids, such as fentanyl, withdrawal begins approximately 4 hours after the last use, whereas withdrawal from methadone, a long-acting opioid, may not occur until 36 hours after the last use.45,46 Appropriate monitoring and symptomatic management are key factors in treating opioid withdrawal. Pharmacologic agents such as opioid agonists, alpha-2 adrenergic agonists, and other nonopioid agents for symptomatic relief should be considered in these patients (Table 32.8).47–49
Kratom (Mitragyna speciosa Korth.) an overlooked medicinal plant in Malaysia
Published in Journal of Substance Use, 2022
Gregory Domnic, Suresh Narayanan, Nethia Mohana-Kumaran, Darshan Singh
Despite the long tradition of kratom use in Southeast Asia little or no serious side effects have been reported. Prolonged users have not reported serious health issues or impaired social functioning (Singh et al., 2016). The widely reported effects from long-term use include skin discoloration and constipation. More serious side effects were related to dependence and subsequent withdrawal. Withdrawal symptoms were both physical and psychological; the former includes muscle spasms, diarrhea, lack of appetite, fever, pain, watery eyes and runny nose. The latter was characterized by mood swings, anger, nervousness, restlessness, insomnia, tension, and sadness (Singh et al., 2014). While these symptoms are no different to those experienced during opioid withdrawal, the majority of the self-reports suggest that they were not as severe and lasted for shorter periods (Hassan et al., 2013; Singh et al., 2014, 2018b).
Management of kratom dependence with buprenorphine/naloxone in a veteran population
Published in Substance Abuse, 2021
Jamie Lei, Amy Butz, Natalie Valentino
Reported withdrawal symptoms from the published cases and these additional cases were mostly subjective. Symptoms appear to be similar to opioid withdrawal, including chills, gastrointestinal discomfort, myalgia, rhinorrhea, anxiety, and restlessness. Kratom withdrawal may persist for longer (up to three months after discontinuation) compared to typical opioid withdrawal (about one week). Currently there is no known reason for this as the mechanism of the substance has not been fully described. For management of OUD, typically dose increases are used to control ongoing withdrawal symptoms and cravings for opioids. Increased and divided dosing were used in these cases due to reported “wearing off” of buprenorphine effects and for co-morbid pain. Increasing buprenorphine/naloxone and divided dosing may be beneficial in prolonged withdrawal. Further research is needed on the anticipated duration of withdrawal symptoms from kratom and best practices in management.
A Complex Case of Kratom Dependence, Depression, and Chronic Pain in Opioid Use Disorder: Effects of Buprenorphine in Clinical Management
Published in Journal of Psychoactive Drugs, 2020
This case study has several limitations. There was no available lab test to determine whether the patient was using Kratom or other plant-based products made of Kratom. His admission urine drug screen was negative for all substances. Second, he reported that he had not used prescription opioids for a year prior to his presentation to us, however there was no way to confirm this. Third, the worsening of the reported health conditions may have resulted from discontinuation of prescription of opioids (the patient’s opioid medication was controlled and no longer attainable, thus he used kratom) or the long-term use of prescription opioids. The timeline of opioid withdrawal symptoms varies amongst users and symptoms typically resolve within four weeks (Vaughan and Kleber 2015). It is therefore unlikely that his symptoms were attributable to prescription opioid withdrawal which would have totally resolved by the time he was evaluated in our clinic a year later.