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Opioid WithdrawalAPPROACH

TOXICOLOGY AND BEHAVIORAL · 19 SECTIONS

⚲

442 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Undifferentiated Overdose Opioid Toxicity Opioid Withdrawal Alcohol Intoxication Alcohol Withdrawal Stimulant Toxicity Pediatric Ingestion Carbon Monoxide Exposure Inhalational Or Chemical Exposure Suicidal Ideation And Self Harm Risk Assessment Acute Psychosis And Mania Symptoms Anxiety And Panic Symptoms Capacity Assessment And Safe Disposition Behavioral Escalation And Restraint Considerations

Pediatrics16▾

Environmental and Exposure4▾

01History/hx66

Presentation overview

›Withdrawal context

›Time since last opioid use

›Typical opioid used

›Route

›Amount and frequency

›Long acting exposure

›Methadone

›Extended release oxycodone

›Fentanyl

›Prior withdrawal episodes

›Prior severe withdrawal

›Prior delirium

›Prior seizures

›Prior opioid agonist treatment

›Buprenorphine

›Methadone

›Naltrexone

OPQRST

›Withdrawal symptom characterization

›Onset

›First symptoms after last use

›Peak symptom timing

›Provocation and palliation

›Worse with missed doses

›Relief with opioid use

›Relief with clonidine class agents

›Quality

02Alarm Features/alarm29

Immediate escalation triggers

›High risk physiology

›Hypoxia

›Respiratory rate less than 10

›Systolic blood pressure less than 90

›Heart rate greater than 130

›Temperature 38.5 or higher

›Persistent vomiting with inability to tolerate fluids

›Severe dehydration

›High risk mental status

›Delirium

›Severe agitation with unsafe behavior

Alternate diagnosis red flags

›Infection and sepsis

›Fever with rigors

›Focal infection symptoms

›Toxicologic emergencies

›Sedative hypnotic withdrawal suspected

›Alcohol withdrawal suspected

›GI and surgical

›Peritonitis findings

›Hematemesis

›Cardiopulmonary

›Chest pain

›Syncope

Opioid specific safety

›Recent naloxone reversal

›Recurrent sedation risk

03Medications/meds34

Current medications and recent changes

›Medication reconciliation

›Prescribed opioids

›Opioid agonist therapy

›Buprenorphine formulation

›Methadone dose

›Recent missed doses

›Recent dose changes

›QT prolonging agents

Withdrawal symptom management options

›Alpha 2 agonists

›Clonidine PO 0.1 mg

›Repeat every 6 to 8 hours as needed

›Hold if systolic blood pressure less than 90

›Lofexidine local protocol dependent

›Antiemetics

›Ondansetron ODT 4 mg

›Repeat every 8 hours as needed

›Antidiarrheals

›Loperamide PO 4 mg once

›Then 2 mg after each loose stool

›Maximum 16 mg per day

›Analgesics

›Acetaminophen PO 1000 mg

›Maximum 3000 mg per day if liver risk

›Ibuprofen PO 400 mg

›Repeat every 6 hours as needed

›Sleep and anxiety

04Diet/diet14

Intake and hydration

›Recent intake

›Poor oral intake

›Inability to keep fluids down

›Weight change

›Hydration indicators

›Thirst

›Reduced urine output

›Orthostasis symptoms

Exposures

›Caffeine and energy drinks

›Recent increase

›Palpitations association

›Alcohol

›Recent last drink timing

›Daily intake pattern

05Review of Systems/ros20

Constitutional and autonomic

›System screen

›Fever

›Chills

›Diaphoresis

›Tremor

Cardiopulmonary

›System screen

›Chest pain

›Dyspnea

›Palpitations

Gastrointestinal

›System screen

›Nausea

›Vomiting

›Diarrhea

›Abdominal pain

Neurologic and psychiatric

›System screen

›Headache

›Confusion

›Seizure

›Severe anxiety

›Hallucinations

06Collateral History and Family History/chafh11

Collateral and safety

›Collateral sources

›Family or friend report

›EMS report

›Pharmacy records

›Support and supervision reliability

›Safe place to stay

›Ability to return for worsening

Family history

›Relevant conditions

›Sudden cardiac death in first degree relative younger than 50

›Long QT syndrome

›Substance use disorder in family

07Risk Factors/rf16

Substance and medical risks

›Opioid use pattern risks

›Fentanyl predominant supply exposure

›High tolerance with daily use

›Prior overdose history

›Dehydration and electrolyte risks

›Persistent vomiting

›High volume diarrhea

›Complicated withdrawal risks

›Concurrent alcohol dependence

›Concurrent benzodiazepine dependence

Special populations

›Pregnancy and postpartum

›Pregnancy status unknown

›Breastfeeding

›Adolescents

›Guardian involvement needs

›Confidentiality constraints local protocol dependent

08Differential Diagnosis/ddx36

Life threatening

›High risk alternatives

›Sepsis (A41.9)

›Fever

›Hypotension

›Alcohol withdrawal syndrome (F10.239)

›Tremor

›Autonomic instability

›Benzodiazepine withdrawal (F13.239)

›Seizure risk

›Severe agitation

›Acute coronary syndrome (I24.9)

›Chest pain

›ECG changes

›Diabetic ketoacidosis (E10.10)

›Hyperglycemia symptoms

›Kussmaul breathing

Common

›Likely diagnoses

›Opioid withdrawal (F11.23)

›Mydriasis

›Piloerection

›Viral gastroenteritis (A09)

›Sick contacts

›Fever

›Anxiety or panic disorder (F41.0)

›Hyperventilation

›Triggered episodes

09Past Medical History/pmh15

Medical and psychiatric history

›Relevant conditions

›Opioid use disorder (F11.20)

›Chronic pain syndromes

›Depression (F32.9)

›Anxiety (F41.9)

›Seizure disorder (G40.909)

›Prior complications

›Endocarditis history (I33.0)

›Hepatitis C (B18.2)

Procedures and baseline

›Prior surgeries and devices

›Implanted cardiac devices

›Central venous access devices

›Baseline function

›Housing stability

›Access to follow up

10Physical Exam/exam29

General and vital signs

›Appearance and toxicity

›Agitated versus somnolent

›Diaphoresis

›Hydration status

›Vital sign patterns

›Tachycardia

›Hypertension

›Fever absence supports withdrawal but does not exclude infection

HEENT and pupils

›Key findings

›Mydriasis

›Lacrimation

›Rhinorrhea

Cardiopulmonary

›Key findings

›Tachycardia rhythm regularity

›Murmur suggesting endocarditis

›Work of breathing

Abdomen

›Key findings

›Diffuse tenderness

›Guarding or rebound

›Bowel sounds

Skin and extremities

›Key findings

›Piloerection

›Track marks

11Lab Studies/labs12

Core labs when indicated

›Targeted testing

›Point of care glucose

›Basic metabolic panel

›Pregnancy test in patients with childbearing potential

›CBC if infection concern

›Liver enzymes if hepatic risk or medication planning

Interpretation and pitfalls

›Dehydration and electrolyte complications

›Hypokalemia from vomiting and diarrhea

›Metabolic alkalosis from vomiting

›Urine drug testing limitations

›Does not quantify intoxication severity

›Many synthetic opioids may not be detected

12Imaging/img21

Scoring Systems

›Withdrawal severity tools

›Clinical Opiate Withdrawal Scale

›Score interpretation ranges

›Mild

›Moderate

›Severe

›Use when

›Objective withdrawal assessment for treatment titration

›Monitoring response after buprenorphine

›Avoid when

›Severe agitation preventing reliable scoring

›Mixed intoxication with sedation

MRI

›Indications in atypical presentations

›Suspected spinal epidural abscess with back pain and neurologic deficit

›Suspected intracranial pathology with focal deficit

›Indications in atypical presentations

›CT head if altered mental status or trauma

›CT abdomen pelvis if peritonitis or severe focal abdominal pain

Ultrasound

›Bedside applications

›IVC assessment for volume status adjunct

›Soft tissue ultrasound for abscess if injection related infection concern

13Special Tests/spec9

Bedside toxicology and infection screening

›Targeted bedside tests

›Breath alcohol if withdrawal overlap suspected

›Rapid respiratory viral testing when febrile syndrome

›Infectious workup triggers

›Blood cultures if febrile with sepsis concern

›Lactate if shock physiology

Pregnancy related testing

›Pregnancy and complications

›Urine or serum pregnancy test

›Point of care ultrasound if unstable with abdominal pain and bleeding

14ECG/ecg11

Indications and high risk findings

›When needed

›Methadone use

›Syncope

›Palpitations

›Electrolyte abnormalities suspected

›Key risks

›QTc prolongation

›Ventricular ectopy

Serial ECG logic

›Monitoring approach

›Repeat after electrolyte correction if prolonged QTc

›Repeat if new chest pain or hemodynamic change

15Assessment/ax21

Working diagnosis and severity

›Opioid withdrawal (F11.23)

›Objective signs

›Mydriasis

›Diaphoresis

›Symptom burden

›Vomiting frequency

›Diarrhea volume

›Severity stratification

›Mild

›Able to tolerate oral fluids

›Minimal autonomic instability

›Moderate to severe

›Unable to tolerate oral fluids

›Significant tachycardia or hypertension

Complications and uncertainty

›Complications to rule out

›Dehydration

›Electrolyte derangement

›Concurrent sedative withdrawal

›Alternative diagnosis flags

›Fever or focal infection symptoms

›Focal neurologic deficits

16Plan/plan51

Differential Management

›!Opioid withdrawal→

Approach to the critical patient

›First 5 minutes workflow

›Airway and breathing

›If hypoventilation or hypoxia, treat as opioid toxicity pathway

›Naloxone titration if opioid intoxication present

›Circulation

›IV access if dehydration or severe symptoms

›Isotonic fluids if orthostasis or poor intake

›Monitoring

›Continuous pulse oximetry if sedating co ingestion suspected

›Cardiac monitoring if severe autonomic instability

Buprenorphine treatment

›Initiation criteria

›Objective withdrawal present

›Moderate withdrawal severity

›Sufficient time since last short acting opioid use

›Standard induction example adult

›Buprenorphine naloxone SL 4 mg

›Reassess in 45 to 60 minutes

›Additional 4 mg if symptoms persist

›Typical day 1 total 8 to 16 mg

›Precipitated withdrawal risk

›Higher risk with fentanyl exposure

›Higher risk with long acting opioids

›Alternative initiation strategies

›Micro induction local protocol dependent

17Disposition/dispo19

Level of care criteria

›ICU or resuscitation area

›Airway risk

›Refractory shock physiology

›Severe agitation requiring continuous sedation

›Inpatient admission

›Persistent inability to tolerate oral intake

›Significant electrolyte abnormalities

›Concurrent alcohol or benzodiazepine withdrawal

›Serious infection concern

›Observation pathway

›Buprenorphine induction monitoring

›Ongoing vomiting needing IV therapy

Discharge criteria

›Clinical stability

›Vital signs stable

›Tolerating oral fluids

›Symptoms controlled with outpatient plan

›Follow up reliability

›Access to next day addiction follow up

›Safe discharge destination

18Discharge Instructions/di22

Copy discharge instructions

›Opioid withdrawal

›Symptoms are from the body adjusting after stopping opioids

›Symptoms usually improve over several days

›Medications

›Take buprenorphine exactly as prescribed if started

›Avoid alcohol and sedating drugs while taking new medications

›Use ondansetron only as directed for nausea

›Use loperamide only as directed for diarrhea

›Fluids and food

›Sip fluids often

›Use oral rehydration solutions if diarrhea or vomiting

›Follow up

›Addiction treatment follow up within 24 to 72 hours

›Primary care follow up within 1 week

›Return to emergency

›Trouble breathing

›Fainting

›Chest pain

›Persistent vomiting with inability to drink

›Confusion

›Fever 38.5 or higher

›Worsening severe weakness

19References/r6

Guidelines and key sources

›Evidence base

›ASAM National Practice Guideline for the Treatment of Opioid Use Disorder 2020 focused update

›SAMHSA TIP 63 Medications for Opioid Use Disorder 2021 update

›WHO Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence 2009

›NICE Guideline NG46 Controlled drugs safe use and management 2016 updated

›CDC Clinical Practice Guideline for Prescribing Opioids for Pain 2022

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Opioid WithdrawalAPPROACH

TOXICOLOGY AND BEHAVIORAL · 19 SECTIONS

⚲

442 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx66

Presentation overview

›Withdrawal context

›Time since last opioid use

›Typical opioid used

›Route

›Amount and frequency

›Long acting exposure

›Methadone

›Extended release oxycodone

›Fentanyl

›Prior withdrawal episodes

›Prior severe withdrawal

›Prior delirium

›Prior seizures

›Prior opioid agonist treatment

›Buprenorphine

›Methadone

›Naltrexone

OPQRST

›Withdrawal symptom characterization

›Onset

›First symptoms after last use

›Peak symptom timing

›Provocation and palliation

›Worse with missed doses

›Relief with opioid use

›Relief with clonidine class agents

›Quality

02Alarm Features/alarm29

Immediate escalation triggers

›High risk physiology

›Hypoxia

›Respiratory rate less than 10

›Systolic blood pressure less than 90

›Heart rate greater than 130

›Temperature 38.5 or higher

›Persistent vomiting with inability to tolerate fluids

›Severe dehydration

›High risk mental status

›Delirium

›Severe agitation with unsafe behavior

Alternate diagnosis red flags

›Infection and sepsis

›Fever with rigors

›Focal infection symptoms

›Toxicologic emergencies

›Sedative hypnotic withdrawal suspected

›Alcohol withdrawal suspected

›GI and surgical

›Peritonitis findings

›Hematemesis

›Cardiopulmonary

›Chest pain

›Syncope

Opioid specific safety

›Recent naloxone reversal

›Recurrent sedation risk

03Medications/meds34

Current medications and recent changes

›Medication reconciliation

›Prescribed opioids

›Opioid agonist therapy

›Buprenorphine formulation

›Methadone dose

›Recent missed doses

›Recent dose changes

›QT prolonging agents

Withdrawal symptom management options

›Alpha 2 agonists

›Clonidine PO 0.1 mg

›Repeat every 6 to 8 hours as needed

›Hold if systolic blood pressure less than 90

›Lofexidine local protocol dependent

›Antiemetics

›Ondansetron ODT 4 mg

›Repeat every 8 hours as needed

›Antidiarrheals

›Loperamide PO 4 mg once

›Then 2 mg after each loose stool

›Maximum 16 mg per day

›Analgesics

›Acetaminophen PO 1000 mg

›Maximum 3000 mg per day if liver risk

›Ibuprofen PO 400 mg

›Repeat every 6 hours as needed

›Sleep and anxiety

04Diet/diet14

Intake and hydration

›Recent intake

›Poor oral intake

›Inability to keep fluids down

›Weight change

›Hydration indicators

›Thirst

›Reduced urine output

›Orthostasis symptoms

Exposures

›Caffeine and energy drinks

›Recent increase

›Palpitations association

›Alcohol

›Recent last drink timing

›Daily intake pattern

05Review of Systems/ros20

Constitutional and autonomic

›System screen

›Fever

›Chills

›Diaphoresis

›Tremor

Cardiopulmonary

›System screen

›Chest pain

›Dyspnea

›Palpitations

Gastrointestinal

›System screen

›Nausea

›Vomiting

›Diarrhea

›Abdominal pain

Neurologic and psychiatric

›System screen

›Headache

›Confusion

›Seizure

›Severe anxiety

›Hallucinations

06Collateral History and Family History/chafh11

Collateral and safety

›Collateral sources

›Family or friend report

›EMS report

›Pharmacy records

›Support and supervision reliability

›Safe place to stay

›Ability to return for worsening

Family history

›Relevant conditions

›Sudden cardiac death in first degree relative younger than 50

›Long QT syndrome

›Substance use disorder in family

07Risk Factors/rf16

Substance and medical risks

›Opioid use pattern risks

›Fentanyl predominant supply exposure

›High tolerance with daily use

›Prior overdose history

›Dehydration and electrolyte risks

›Persistent vomiting

›High volume diarrhea

›Complicated withdrawal risks

›Concurrent alcohol dependence

›Concurrent benzodiazepine dependence

Special populations

›Pregnancy and postpartum

›Pregnancy status unknown

›Breastfeeding

›Adolescents

›Guardian involvement needs

›Confidentiality constraints local protocol dependent

08Differential Diagnosis/ddx36

Life threatening

›High risk alternatives

›Sepsis (A41.9)

›Fever

›Hypotension

›Alcohol withdrawal syndrome (F10.239)

›Tremor

›Autonomic instability

›Benzodiazepine withdrawal (F13.239)

›Seizure risk

›Severe agitation

›Acute coronary syndrome (I24.9)

›Chest pain

›ECG changes

›Diabetic ketoacidosis (E10.10)

›Hyperglycemia symptoms

›Kussmaul breathing

Common

›Likely diagnoses

›Opioid withdrawal (F11.23)

›Mydriasis

›Piloerection

›Viral gastroenteritis (A09)

›Sick contacts

›Fever

›Anxiety or panic disorder (F41.0)

›Hyperventilation

›Triggered episodes

09Past Medical History/pmh15

Medical and psychiatric history

›Relevant conditions

›Opioid use disorder (F11.20)

›Chronic pain syndromes

›Depression (F32.9)

›Anxiety (F41.9)

›Seizure disorder (G40.909)

›Prior complications

›Endocarditis history (I33.0)

›Hepatitis C (B18.2)

Procedures and baseline

›Prior surgeries and devices

›Implanted cardiac devices

›Central venous access devices

›Baseline function

›Housing stability

›Access to follow up

10Physical Exam/exam29

General and vital signs

›Appearance and toxicity

›Agitated versus somnolent

›Diaphoresis

›Hydration status

›Vital sign patterns

›Tachycardia

›Hypertension

›Fever absence supports withdrawal but does not exclude infection

HEENT and pupils

›Key findings

›Mydriasis

›Lacrimation

›Rhinorrhea

Cardiopulmonary

›Key findings

›Tachycardia rhythm regularity

›Murmur suggesting endocarditis

›Work of breathing

Abdomen

›Key findings

›Diffuse tenderness

›Guarding or rebound

›Bowel sounds

Skin and extremities

›Key findings

›Piloerection

›Track marks

11Lab Studies/labs12

Core labs when indicated

›Targeted testing

›Point of care glucose

›Basic metabolic panel

›Pregnancy test in patients with childbearing potential

›CBC if infection concern

›Liver enzymes if hepatic risk or medication planning

Interpretation and pitfalls

›Dehydration and electrolyte complications

›Hypokalemia from vomiting and diarrhea

›Metabolic alkalosis from vomiting

›Urine drug testing limitations

›Does not quantify intoxication severity

›Many synthetic opioids may not be detected

12Imaging/img21

Scoring Systems

›Withdrawal severity tools

›Clinical Opiate Withdrawal Scale

›Score interpretation ranges

›Mild

›Moderate

›Severe

›Use when

›Objective withdrawal assessment for treatment titration

›Monitoring response after buprenorphine

›Avoid when

›Severe agitation preventing reliable scoring

›Mixed intoxication with sedation

MRI

›Indications in atypical presentations

›Suspected spinal epidural abscess with back pain and neurologic deficit

›Suspected intracranial pathology with focal deficit

›Indications in atypical presentations

›CT head if altered mental status or trauma

›CT abdomen pelvis if peritonitis or severe focal abdominal pain

Ultrasound

›Bedside applications

›IVC assessment for volume status adjunct

›Soft tissue ultrasound for abscess if injection related infection concern

13Special Tests/spec9

Bedside toxicology and infection screening

›Targeted bedside tests

›Breath alcohol if withdrawal overlap suspected

›Rapid respiratory viral testing when febrile syndrome

›Infectious workup triggers

›Blood cultures if febrile with sepsis concern

›Lactate if shock physiology

Pregnancy related testing

›Pregnancy and complications

›Urine or serum pregnancy test

›Point of care ultrasound if unstable with abdominal pain and bleeding

14ECG/ecg11

Indications and high risk findings

›When needed

›Methadone use

›Syncope

›Palpitations

›Electrolyte abnormalities suspected

›Key risks

›QTc prolongation

›Ventricular ectopy

Serial ECG logic

›Monitoring approach

›Repeat after electrolyte correction if prolonged QTc

›Repeat if new chest pain or hemodynamic change

15Assessment/ax21

Working diagnosis and severity

›Opioid withdrawal (F11.23)

›Objective signs

›Mydriasis

›Diaphoresis

›Symptom burden

›Vomiting frequency

›Diarrhea volume

›Severity stratification

›Mild

›Able to tolerate oral fluids

›Minimal autonomic instability

›Moderate to severe

›Unable to tolerate oral fluids

›Significant tachycardia or hypertension

Complications and uncertainty

›Complications to rule out

›Dehydration

›Electrolyte derangement

›Concurrent sedative withdrawal

›Alternative diagnosis flags

›Fever or focal infection symptoms

›Focal neurologic deficits

16Plan/plan51

Differential Management

›!Opioid withdrawal→

Approach to the critical patient

›First 5 minutes workflow

›Airway and breathing

›If hypoventilation or hypoxia, treat as opioid toxicity pathway

›Naloxone titration if opioid intoxication present

›Circulation

›IV access if dehydration or severe symptoms

›Isotonic fluids if orthostasis or poor intake

›Monitoring

›Continuous pulse oximetry if sedating co ingestion suspected

›Cardiac monitoring if severe autonomic instability

Buprenorphine treatment

›Initiation criteria

›Objective withdrawal present

›Moderate withdrawal severity

›Sufficient time since last short acting opioid use

›Standard induction example adult

›Buprenorphine naloxone SL 4 mg

›Reassess in 45 to 60 minutes

›Additional 4 mg if symptoms persist

›Typical day 1 total 8 to 16 mg

›Precipitated withdrawal risk

›Higher risk with fentanyl exposure

›Higher risk with long acting opioids

›Alternative initiation strategies

›Micro induction local protocol dependent

17Disposition/dispo19

Level of care criteria

›ICU or resuscitation area

›Airway risk

›Refractory shock physiology

›Severe agitation requiring continuous sedation

›Inpatient admission

›Persistent inability to tolerate oral intake

›Significant electrolyte abnormalities

›Concurrent alcohol or benzodiazepine withdrawal

›Serious infection concern

›Observation pathway

›Buprenorphine induction monitoring

›Ongoing vomiting needing IV therapy

Discharge criteria

›Clinical stability

›Vital signs stable

›Tolerating oral fluids

›Symptoms controlled with outpatient plan

›Follow up reliability

›Access to next day addiction follow up

›Safe discharge destination

18Discharge Instructions/di22

Copy discharge instructions

›Opioid withdrawal

›Symptoms are from the body adjusting after stopping opioids

›Symptoms usually improve over several days

›Medications

›Take buprenorphine exactly as prescribed if started

›Avoid alcohol and sedating drugs while taking new medications

›Use ondansetron only as directed for nausea

›Use loperamide only as directed for diarrhea

›Fluids and food

›Sip fluids often

›Use oral rehydration solutions if diarrhea or vomiting

›Follow up

›Addiction treatment follow up within 24 to 72 hours

›Primary care follow up within 1 week

›Return to emergency

›Trouble breathing

›Fainting

›Chest pain

›Persistent vomiting with inability to drink

›Confusion

›Fever 38.5 or higher

›Worsening severe weakness

19References/r6

Guidelines and key sources

›Evidence base

›ASAM National Practice Guideline for the Treatment of Opioid Use Disorder 2020 focused update

›SAMHSA TIP 63 Medications for Opioid Use Disorder 2021 update

›WHO Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence 2009

›NICE Guideline NG46 Controlled drugs safe use and management 2016 updated

›CDC Clinical Practice Guideline for Prescribing Opioids for Pain 2022

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.