OPIATE INPATIENT DETOX CHEAT SHEET
Author: Daniel Carlat M.D.
Last Updated: 4/19/20
How to determine if a patient is likely to need opiate detox.
- Two weeks of regular use (2 to 3 times per day) leads to tolerance and withdrawal.
- Note that many opioid using patients may also be alcohol users, and may require dual alcohol/opiate detox
Detox symptoms
Symptoms begin about 8-12 hours after last use, and last for 3-4 days, with symptoms gone within 7 days.
- Stomach symptoms: Nausea, diarrhea, loss of appetite
- Muscle symptoms: Muscle aches, cramps, twitches
- Facial symptoms: runny nose, watery eyes
- Skin: Goose flesh, feeling cold, feeling sweaty or clammy
- Brain: Craving, anxiety, insomnia
Labs to order on admission
- HIV
- Hepatitis A, B, and C
- Complete blood count
- Liver function tests
- Pregnancy test
Medications for detox
Suboxone detox—4 day scheduled detox:
- Day 1: Suboxone 4 mg BID
- Day 2: 4 mg AM, 2 mg PM
- Day 3: 2 mg BID
- Day 4: 2 mg AM
Suboxone detox—Symptom triggered detox based on COWS scale:
- Day 1: Suboxone 2 mg Q6 prn COWS >6
- Day 2: Suboxone 2 mg Q8 prn COWS >6
- Day 3: Suboxone 2 mg Q12 prn COWS >6
- Day 4: Suboxone 2 mg QD prn COWS >6
Comfort meds, made available to patient on suboxone detox as needed, also can be used for opioid detox without suboxone:
- Clonidine 0.1-0.2mg Q 6 prn anxiety (NTE 1.2 mg/24 hours, hold if BP <100/70)
- Hydroxyzine 50 mg Q 6 prn insomnia/anxiety
- Ibuprofen 600 mg Q 6 prn pain
- Acetaminophen 650 mg Q 6 prn pain
- Baclofen 10 mg BID prn muscle spasms
- Ondansetron (Zofran) 4 mg Q 6 prn nausea
- Metoclopramide (Reglan) 5 mg Q 6 prn nausea
- Dicyclomine (Bentyl) 20 mg Q 4 prn abdominal cramps
- Loperimide (Imodium) 2 mg Q 2 prn diarrhea (NTE 16 mg/24 hours)
- Trazodone 50 mg QHS prn insomnia