Who Is Likely to Experience Withdrawal Symptoms? ⦁ It’s hard to predict whether a particular person will experience withdrawal or how severe their symptoms will be. Generally speaking, anyone who consistently takes an opioid for two weeks or longer is at risk.

Initial Questions As with any psychiatric interview, start by building an alliance and showing interest in your patient in a general way. The first few questions, although not explicitly related to psychiatric issues, will typically naturally transition to the patient’s reason for their visit. ⦁ “Where are you from?” ⦁ “What do you do for work and fun?”

The Clinical Opiate Withdrawal Scale (COWS) is an 11-item scale used for rating the degree of opioid withdrawal. See our accompanying fact sheet that reproduces the entire scale for your use. While the COWS may appear straightforward, it can be confusing when using it to assess patients undergoing withdrawal in the real world. In this fact sheet, we offer some hard-won tips and pitfalls to avoid so that you can more accurately rate your patient’s withdrawal symptoms.

Like all substance use disorders, opioid use disorder (OUD), defined by the DSM-5, includes 11 criteria. While most experienced clinicians can diagnose OUD without going through a formal checklist of symptoms, we suggest you try using this sheet during interviews. You are likely to find it helpful in at least two ways.

This medication is used to help manage moderate to severe opioid use disorder. It is also used to provide relief from moderate to severe pain.

The illicit opioid supply has become increasingly unpredictable. Over the last 10 years, fentanyl and its derivatives have found their way into this supply and have become key contributors to the continued increase in overdose deaths. One of the most concerning and persistent additives is xylazine, known on the street as “tranq.” Here, we will cover the basic pharmacology of xylazine, why it’s so concerning, what to look out for if you suspect it, and how to counsel your patients.

Drug overdose deaths, the vast majority of which involve opioids, continue to rise in the US. Health care providers should be able to identify patients at particularly high risk for overdose, know how to mitigate risk using harm reduction strategies, and educate patients to recognize and quickly treat overdose. (See “Opioid Overdose Overview Fact Sheet for Patients.”)

Rationale for Microinduction The standard method of starting a patient on buprenorphine (see “How to Discuss and Initiate Buprenorphine” fact sheet) involves having the patient stop all opioids hours to days before the induction. This period is needed because buprenorphine can trigger opioid withdrawal if given when the patient still has most of their opioid receptors occupied by agonists. T

The global supply of illicit opioids is rapidly shifting and unstable. Fentanyl went from being an occasional contaminant to nearly completely taking over street opioids in the span of just a few years. More often than not, patients obtain different opioid drugs from a variety of sources. Depending on what is available at a given time, the same person may be sniffing, smoking, injecting, or swallowing different varieties of opioids, some illegal (such as heroin), some legal but illicitly obtained (such as OxyContin), and some legal drugs that were manufactured illicitly (such as fentanyl). In this fact sheet, we introduce you to the landscape of street opioids in order to help you understand what your patients are using and allow you to speak their language.

Opioids can cause a bad and potentially fatal reaction (overdose) that makes your breathing slow or even stop, which can be fatal. Opioids include prescriptions such as hydrocodone, oxycodone, morphine, codeine, and hydromorphone. Other opioids are heroin and fentanyl, which can be obtained illicitly or may contaminate street drugs like cocaine, methamphetamine, or counterfeit pills.