Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

TABLE 7.2. Opioid Withdrawal7. Opioids 143Stage I—begins within hours of last dose and peaks at 36–72 hours:1. Craving for the drug.2. Tearing (lacrimation).3. “Runny nose” (rhinorrhea).4. Yawning.5. Sweating (diaphoresis).Stage II—begins at 12 hours and peaks at 72 hours:1. Mild-to-moderate sleep disturbance.2. Dilated pupils (mydriasis).3. Loss of appetite (anorexia).4. “Goose flesh” or “cold turkey” (piloerection).5. Irritability.6. Tremor.Stage III—begins at 24–36 hours and peaks at 72 hours:1. Severe insomnia.2. Violent yawning.3. Weakness.4. Nausea, vomiting, and diarrhea.5. Chills and fever.6. Muscle spasms or “kicking the habit” (especially in the lower extremities).7. Flushing.8. Spontaneous ejaculation.9. Abdominal pain.TABLE 7.3. Opioid Overdose1. Signs of recent ingestion.2. Profoundly decreased respirations or apnea.3. Pale skin and blue mucous membranes.4. Pinpoint pupils, unless prolonged cerebral apnea has caused somebrain damage, in which case pupillary dilatation may occur.5. Pulmonary edema resulting in characteristic gasping and audiblerhonchi; occasional froth in the upper airway.6. Cardiovascular collapse.7. Cardiac dysrhythmias.8. Convulsions, especially with meperidine, propoxyphene, or codeine.9. Semicoma or coma.