A 40-year old gentleman comes to your ED in withdrawal. He is a daily drinker, about 24 beers per day, and also uses heroin daily. His last drink was 18 hrs ago, and his last heroin use was 12 hrs ago. He has no history of alcohol withdrawal seizures. You suspect he is in both alcohol and opioid withdrawal. He scores in the mild alcohol withdrawal range on the CIWA-scale and the moderate opioid withdrawal range on the Clinical Opioid Withdrawal Scale (COWS). What is the best approach to his ED management?

About the Author: Anton Helman

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.