Epidemiology

Etiology

• Mostly heroin

Pathophysiology

Clinical features

• CNS arousal and sympathetic hyperactivity
  • Tachycardia, hypertension
  • Anxiety, insomnia, irritability, agitation
  • Mydriasis, yawning, lacrimation, sneezing
  • Hyperreflexia, muscle cramps
• Flu-like symptoms
  • Rhinorrhea, diaphoresis, piloerection, thermoregulation disturbances (e.g., chills)
  • Myalgia, arthralgia
• Gastrointestinal symptoms
  • Nausea, vomiting, diarrhea
  • Abdominal pain, hyperactive bowel sounds

Neonatal abstinence syndrome

Neonatal abstinence syndrome is caused by maternal drug use during pregnancy (typically opioids) that subsequently leads to a withdrawal reaction in the infant.

Clinical features

• Symptoms usually manifest in the first days of life.
• Flu-like symptoms: fever and sweating
• Gastrointestinal symptoms
  • Poor feeding
  • Vomiting, diarrhea
  • Failure to thrive
• Respiratory symptoms
  • Tachypnea, apnea
  • Sneezing, nasal congestion
• Sympathetic hyperactivity: hypertension, tachycardia
• CNS stimulation
  • High pitched crying, irritability
  • Muscle tone and movement disorders (e.g., hyperreflexia, tremor, jerking)
  • Seizures
  • Uncoordinated sucking reflexes

Diagnostics

Treatment

• Acute opioid withdrawal: methadone/buprenorphine
  • Methadone
    • full mu-opioid receptor agonist
    • It has a long half-life, which allows it to effectively suppress cravings and withdrawal symptoms
    • It also blocks the euphoric effects of other opioids by maintaining high tolerance levels
    • Adverse effect: Long QT syndromes and torsade de pointes
  • Buprenorphine is an opioid partial agonist used for opioid use disorder