OPIATES

Found in illicit drugs, codeine, morphine, meperidine (Demerol), Percocet , methadone.

 Two distinct entities that ER healthcare commonly  encounter are OD and  WD.

1. OD - presents with  AMS, drowsiness, pinpoint pupils and hypoventilation.  If  hypoventilation is not present or is not life threatening i.e. pt's O2 SAT is > 95% on RA and RR is > 10/min, pt can be observed. But if  these symptoms are present, pt is given Naloxone (Narcan) 0.4-2 mg IV, SQ, IM or ETT and the WD symptoms (agitation, N/V, uncooperative pt, yawning) are seen within 1-2 min. It is important to remember  that the T1/2 of Naloxone is 1 hr and pt may return to hypoventilation and somnolent state  once the Naloxone's effect is over. If  this is the case, pt can be put on Naloxone drip (2 mg Narcan  in 500 ml will give 0.4 mg/100 ml and is given at 0.4 mg/hr). It is not uncommon to have only few S & S of  WD e.g. only yawning, thus one doesn't has to have the whole constellation  of WD symptoms to be properly diagnosed as opiates OD.  If opiate ingested is known it is possible to predict the length of intoxicated state. Heroin is usually "out of system" in 12 hrs. and Methadone in 24 hrs.
   NOTE!!! Pts that had suffered  apnea are prone to NCPE/ARDS (that can develop any time within 24 hr.) and if pt develops hypoxia, consider Cxray to r/o NCPE/ARDS
    
2. WD - presents with flu-like symptoms such as runny nose, myalgia, vomiting and more specific findings such as yawning, piloerection, diarrhea, abdominal pain, tachycardia. Pt can be treated with Clonidine 0.1mg  PO or if pt is on Methadone and exact dose is impossible to find out  10 mg of Methadone can be given to keep the pt "off  the edge".

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