1. Clinical Opiate Withdrawal – Symptom Management Protocol
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Clinical Opiate Withdrawal – Symptom Management Protocol
Estimated Length: 9 minutes
April 2015

2. Northwestern Ontario vs. Ontario
Student Drug use - Northwestern Ontario versus Ontario
Substance
Northwestern Ontario
Ontario
Alcohol
66.7%
62%
Cocaine
6.0%
4.4%
Crack
3.3%
2.0%
Oxycontin
4.5%

3. Thunder Bay and IV Drug-Use
On average, Superior Points (Thunder Bay alone) distributes 60,000 needles a month.
Walker, B. (2010)

4. Definitions
Substance Abuse - a pattern of harmful use of any substance for mood-altering purposes.
Addiction - a strong or harmful need to regularly have something or do something.
Tolerance - occurs when the person no longer responds to a drug in the way that they initially responded.
Dependence – a compulsive need to use a drug in order to function normally.
The Four C’s
Craving
Continued use – despite harm
Compulsion to use
Control – loss of

5. Opioid Withdrawal
The discontinuation of an opioid will lead to a constellation of withdrawal symptoms. Withdrawal symptoms occur in stages, depending on time of the last dose and the half-life of opioid used. Heroin reaches a peak in three to four days, where buprenorphine and methadone peak at four to eight days.
Weaver, M. Hopper, J. (2013)

6. Withdrawal stages for heroin: 3 to 4 hours
Drug craving
Anxiety
Fear of withdrawal.
Weaver, M. Hopper, J. (2013)

7. Withdrawal stages for heroin: 8 to 14 hours
Anxiety
Restlessness
Insomnia
Yawning
Rhinorrhea - runny nose
Lacrimation - tearing
Diaphoresis - sweating
Stomach cramps
Mydriasis – dilation of pupils
Weaver, M. Hopper, J. (2013)

8. Withdrawal stages for heroin: 1 to 3 days
Tremors
Muscle spasms
Vomiting
Diarrhea
Tachycardia
Chills
Piloerection – goose bumps
Weaver, M. Hopper, J. (2013)

9. Clinical Opiate Withdrawal Scale

10. Clinical Opiate Withdrawal Scale

11. Clinical Opiate Withdrawal – Symptom Management Protocol
This is a Pre-Printed Direct order that was developed to treat patients with opiate withdrawal and the various symptoms that they might have. The score provided by Clinical Opiate Withdrawal Scale will provide the nurse and physician to adequately treat opiate withdrawal symptoms.

12. The Clinical Opioid Withdrawal – Symptom Management Protocol
The pre-printed direct order will be used in conjunction with the COWS scale to administer appropriate doses of clonidine in order to manage opiate withdrawal effectively.
The protocol will also use appropriate medication to manage symptoms, such as nausea, diarrhea, anxiety and insomnia.
The physician can determine whether to follow the PPDO or follow another therapy at their discretion.

13. COWS – Symptom Management

14. COWS – Initiating Clonidine

15. Assessments

16. Opioid Dependence
Opioid dependence is a chronic, relapsing illness. Patients that have gone through an acute withdrawal period have only gone through the first step.

17. Thank you
If you have any questions, feel free to contact your Clinical Nurse Specialist

18. References
Mood Disorder Society of Canada (2009) Quick Facts: Mental Illness and Addictions in Canada[3rd Ed.] Sieswerda, L. Starkes, J. Adlaf, E. (2006) AD00/0/05NWOSDUSExecSummary.pdf Walker, B. (2010) Pills knock off cocaine as drug of choice in city knock-off-cocaine-as-drug-of-choice-in-city/ Weaver, M. Hopper, J. (2013) Medically supervised opioid withdrawal during treatment for addiction addiction?source=search_result&search=opioid+withdrawal&selectedTitle=2%7E94 Wesson, D. Ling, W. (2003) The Clinical Opiate Wtihdrawal Scale (COWS) Journal of Psychoactive Drugs 35,2 P. 253 – 259