What conditions should be included in the differential diagnoses of opioid abuse?

Updated: Jun 21, 2018
  • Author: David W Dixon, DO; Chief Editor: Glen L Xiong, MD  more...
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Antisocial personality

Panic attack

Pontine infarct or hemorrhage

Depressed mood

Although GI symptoms of nausea, vomiting, and abdominal pain are predominant and common in opioid withdrawal, they may warrant consideration of gastroenteritis, pancreatitis, peptic ulcer disease, and intestinal obstruction.

Sympathetic overactivity must lead to consideration of panic attacks and CNS stimulants, such as amphetamines.

Because multi-drug abuse is common, investigate intoxication by drugs other than narcotics (benzodiazepines, barbiturates) in unconscious patients. A person who abuses opioids may conceal information about other abusive drugs. Because opioid intoxication generally does not cause tremulousness, delirium, and seizures, their presence should raise suspicion of alcohol and benzodiazepine dependence.

Small-sized pupils are observed in opioid intoxication, pontine lesions, and local cholinergic drops.

An antisocial personality may be mistaken as addictive behaviors (and vice versa), especially if confrontation with the law is involved.

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