Table 1. Common Signs of Opioid Intoxication and Withdrawal
Intoxication Signs
• Drooping eyelids
• Constricted pupils
• Reduced respiratory rate
• Scratching (due to histamine release)
• Head nodding
Withdrawal Signs
OOWS SOWS COWS
• Yawning
• Rhinorrhoea
• Piloerection (observe
arm)
• Perspiration
• Lacrimation
• Tremor (hands)
• Mydriasis
• Hot and cold flushes
• Restlessness
• Vomiting
• Muscle twitches
• Abdominal cramps
• Anxiety
• I feel anxious.
• I feel like yawning.
• I'm perspiring.
• My eyes are tearing.
• My nose is running.
• I have goose flesh.
• I am shaking.
• I have hot flashes.
• I have cold flashes.
• My bones and muscles
ache.
• I feel restless.
• I feel nauseous.
• I feel like vomiting.
• My muscles twitch.
• I have cramps in my
stomach.
• I feel like shooting up
now.
• Pulse
• Sweating
• Restlessness
• Pupil size
• Bone or joint aches
• Rhinorrhea
• Tearing
• GI upset
• Tremor of outstretched
hands
• Yawning
• Anxiety or irritability
• Gooseflesh skin
Table 2. Related Physical Exam Findings in Substance Use
Disorders
System Findings
Dermatologic Abscesses, rashes, cellulitis, thrombosed veins, jaundice,
scars, track marks, pock marks from skin popping
Ear, nose, throat and
eyes
Pupils pinpoint or dilated, yellow sclera, conjunctivitis,
rhinorrhea, rhinitis, excoriation or perforation of nasal
septum, epistaxis, sinusitis, hoarseness or laryngitis
Mouth Poor dentition, gum disease, abscesses
Cardiovascular Murmurs, arrhythmias
Respiratory Asthma, dyspnea, rales, chronic cough, hematemesis
Musculosketetal and
extremeties
Pitting edema, broken bones, traumatic amputations, burns
on fingers
Gastrointestinal Hepatomegaly, hernias
3
