Patients who take opioids regularly before surgery, prescribed or not, can go into withdrawal if their usual dose is missed or reduced in the hospital. Withdrawal is rarely deadly, but it is very uncomfortable, makes pain harder to control and can lead patients to leave against advice.
Key symptoms
- Anxiety, restlessness and craving
- Yawning, runny nose and tearing
- Muscle aches, chills and goose bumps
- Nausea, vomiting, cramps and diarrhea
What you find on exam
- Dilated pupils, sweating and gooseflesh
- Fast heart rate and raised blood pressure
- Clinical Opiate Withdrawal Scale (COWS) score
- Hydration status and the surgical wound
Tests
- Urine drug screen with the patient's consent
- Prescription drug monitoring program history
- Electrolytes and kidney function if vomiting or diarrhea
Treatment basics
- Continue the home opioid or treatment dose (methadone, buprenorphine)
- Start buprenorphine once withdrawal is moderate
- Multimodal pain control: acetaminophen, NSAIDs, regional blocks
- Clonidine, ondansetron and loperamide for symptoms
- Naloxone kit and addiction follow-up at discharge
Red flags
- Severe vomiting or diarrhea with dehydration
- Plans to leave against medical advice
- Oversedation or slow breathing after opioid doses
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Related guides
Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; Open RN, Nursing Pharmacology 2e. Written by Making Synapses. Making Synapses is not affiliated with these organizations.