for painkillers for her abdominal pain. She is sweating, shivering and complains of joint pain.
What can be the substance misuse here?
a. Alcohol
b. Heroin
c. Cocaine
d. LSD
e. Ecstasy
answer: B
Heroin withdrawal
- increased sweating,
- lacrimation, rhinorrhoea,
- urinary frequency, diarrhoea,
- abdominal cramps,
- nausea and vomiting,
- muscle spasm leading to headaches, back aches, e.g. cramps
- twitching,
- arthralgia,
- piloerection,
- pupillary dilatation,
- elevated blood pressure,
- tachycardia,
- anxiety and irritability,
- dysphoria,
- disturbed sleep
• direct effect on receptors in CNS resulting in decreased pain perception, sedation, decreased sex drive, nausea/vomiting, decreased GI motility (constipation and anorexia), and respiratory depression
Toxic Reaction
• typical syndrome includes shallow respirations, miosis, bradycardia, hypothermia, decreased level of consciousness
• management
ABCs
IV glucose
naloxone hydrochloride (Narcan®): 0.4 mg up to 2 mg IV for diagnosis
treatment: intubation and mechanical ventilation, ± naloxone drip, until patient alert
without naloxone (>48 h with long-acting opioids)
• caution with longer half-life; may need to observe for toxic reaction for at least 24 h
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