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Miosis, constipation
4%
2/56
Mydriasis, diaphoresis, rhinorrhea
84%
47/56
Delirium, cardiovascular collapse
2%
1/56
Stomach cramps, hypersomnolence
7%
4/56
Belligerence, impulsiveness
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Mydriasis, diaphoresis, and rhinorrhea are all physical signs of withdrawal from an opioid such as heroin. Individuals who abruptly withdraw from heroin use may see symptoms begin within 24 hours. Flu-like symptoms may be present, including nausea, diarrhea and stomach cramps, and patients often complain of joint and muscle aches. Though symptoms may be severe, they are not life-threatening. Praveen et al. review opioid dependence. Patients in withdrawal are stabilized with the opioid substitution agents methadone and buprenorphine. The alpha-2 receptor agonists lofexidine and clonidine are also useful in the stabilization phase of withdrawal. Bell reviews heroin addiction, noting that the goal of most treatment programs is to reduce street heroin use and associated crime and deviant behavior. Methadone programs have often reduced street heroin use less than expected due to suboptimal dosing and other deviations from evidence-based approaches. Illustration A shows a dilated pupil (mydriasis), characteristic of heroin withdrawal. Illustration B is a chart showing the symptoms and signs of heroin withdrawal based on time since last use. Incorrect Answers: Answer 1: Miosis and constipation are characteristic of opioid intoxication. Answer 3: Delirium and cardiovascular collapse are characteristic of barbiturate withdrawal. Answer 4: Stomach cramps and hypersomnolence are characteristic of amphetamine withdrawal. Answer 5: Belligerence and impulsiveness are characteristic of PCP intoxication.
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