ABSTRACT
This chapter presents a case of a 19-year-old young man who is brought to the general practitioner surgery by his sister with complaints of nausea, vomiting, body ache, fever, shivering and poor sleep over the past 2 days. He admits that the drug clinic was not successful and that he now injects heroin twice a day. He enjoys the rush that he gets, but equally knows that he has needed to use more of the drug to achieve the same effect. He had enrolled in a youth training scheme but dropped out. His pupils appear dilated. He complains of muscle tenderness, but there is no significant finding on systemic examination. Heroin withdrawal typically peaks within 36-48 hours after discontinuation but symptoms persist for 7-14 days. Viral or bacterial gastroenteritis, acute pancreatitis, peptic ulcer or intestinal obstruction may mimic moderate to severe opioid withdrawal and need to be excluded as do psychiatric diagnoses such as mania, agitated depression and panic disorder.
