Category Archives: Heroin Addiction

clinical opiate withdrawal scale

What is the Clinical Opiate Withdrawal Scale?

What is the Clinical Opiate Withdrawal Scale?

Everyone’s experience of addiction is different. Likewise, everyone’s path toward recovery is unique. When it comes to overcoming an addiction to opiates, seeking outside help is a must. For that help to be effective, a treatment plan that is tailored to suit the needs of the individual patient is essential. Rehab facilities have many tools at their disposal, and one of the best ones for assessing a patient’s opiate withdrawal symptoms and experiences is something called the Clinical Opiate Withdrawal Scale. Read on to learn more about this useful tool and how it is used to help people overcome serious addictions.

The Basics

Often abbreviated simply as COWS, the Clinical Opiate Withdrawal Scale is an 11-point scale that is used to rate common symptoms and signs of opiate withdrawal. Unlike the Subjective Opiate Withdrawal Scale, or SOWS, which is a self-reporting tool, it is designed to be administered by a clinician. Each of the 11 listed symptoms are given a score on a scale of 0 to 5, with 5 representing the most severe manifestation of the symptom in question. The patient’s score is then tallied and used to determine a tailored opioid withdrawal treatment plan.

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Clinical Opiate Withdrawal Scale

Which Signs and Symptoms are Assessed on the Scale?

Inpatient and outpatient treatment centers alike have numerous tools at their disposal for helping patients to withdraw safely from opiates. In particular, medications like buprenorphine and suboxone are often prescribed to help manage the most severe and uncomfortable symptoms. In turn, patients are less likely to relapse due to severe discomfort. However, to be effective, these medications must be administered at strategic points in the withdrawal process. The COWS scale is the primary tool that clinicians use to determine not only which medications should be used but when they should be administered.

The 11 signs and symptoms that are assessed on the COWS scale are:

1. Resting pulse rate – The patient’s pulse is monitored regularly. A resting pulse of 80 or below is given a score of zero while a resting pulse of 120 or higher is given a score of five.

2. Gastrointestinal upset – Symptoms may range from none to multiple episodes of vomiting and diarrhea.

3. Sweating – This symptom may not be present at all. On the other end, sweat may be streaming from the face or body.

4. Tremors – Tremors may not be present, or they may be severe enough to interfere with a patient’s ability to speak or move.

5. Restlessness – On the COWS scale, this symptom may not be present at all. In the worst case, the patient may be unable to sit still for more than a few seconds at a time.

6. Yawning – No yawning may be happening at all, or it may be happening as frequently as several times per minute.

7. Pupil size – Pupils may be pin-sized when exposed to light, or they may be extremely dilated on the more severe end of the scale.

8. Irritability and anxiety – Someone experiencing opioid withdrawals may show no sign of anxiety or irritability at all, or they may be so anxious or irritable that they struggle to participate in the assessment.

9. Bone and joint aches – This symptom can range from very mild to so severe that the patient is constantly rubbing their joints and unable to sit still.

10. Gooseflesh skin – Skin may be smooth on one end of the scale or look like gooseflesh on the other.

11. Teary eyes and runny nose – These symptoms may be missing entirely, or the eyes and nose may run constantly on the more severe end of the scale.

Benefits of the COWS Scale

After assessing the patient for each of the 11 symptoms, their score is tallied to determine how severe their withdrawal is. A score of 5 to 12 represents mild withdrawal while a score of 36 or higher represents severe withdrawal. Clinicians may use other scales in conjunction with COWS to gain an even clearer understanding of a patient’s current state; the Buprenorphine Administration Scale, for example, is often used in conjunction with COWS to determine effective doses of that medication as well as when to administer it. With many medications, introducing them too early can have the opposite effect, which can lead to a longer and more difficult withdrawal period.

Are You Looking for Opiate Addiction Treatment?

If you are coping with an addiction to opiates and are ready to regain your freedom from substance abuse, it’s important to understand that help is absolutely vital—and it is readily available. Detoxing from the drug is the first step, and the right inpatient or outpatient treatment program will use the COWS scale or other proven tools to determine the best individualized plan for you. Once detoxing is over, you will be free to begin the real work of addiction recovery and to take the first steps toward a lifetime of sober living.

Bacterial Infection Hidden Epidemic, Taking Lives in Opioid Crisis

The current opioid crisis is responsible for producing a new epidemic among teens and young adults. It’s a potentially-fatal bacterial heart infection called endocarditis.

This condition is most commonly seen in older adults. Now doctors are seeing it in much younger patients more often due to opioid drug use.

What is Endocarditis and How is is Related to Opioid Abuse?

Endocarditis is a bacterial infection of the inner lining of the heart chamber and its valves. The condition occurs when bacteria are enter the body, then are spread through the bloodstream until they attach themselves to damaged parts of the heart. It is spreading through the use of shared needles by IV drug drug users.

The clump of bacteria grows over time, and the infection can be life-threatening if it isn’t treated, according to Dr. Sarah Wakeman, the Medical Director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital.

How Infection is Spread

In a doctor’s office, clinic or hospital setting, a health care worker will swab a patient’s skin with a disinfectant to kill bacteria before administering an injection. The purpose of this step is to avoid pushing bacteria from the skin into the body with the needle. Opioid drug users who are using needles may not be taking this step, which has led to the increase in endocarditis cases.

Endocarditis Treatment Not Enough for Opioid Use Disorder Patients

Endocarditis can be treated using intravenous antibiotics over a long time. If the damage to the heart valves is severe, surgery may be recommended to replace them.

If the patient is also injecting opioids, such as heroin, treating the infection is only treating half of the problem. The opioid use disorder is still present, and the patient will go right back to using once if he doesn’t get appropriate help for the addiction.

According to a 2016 Tufts University study, hospital admissions for endocarditis due to injectable drug use increased from 3,578 in 2000 to 8,530 in 2013. The study also found that a large number of these cases involved young people aged 15-24.

States Looking to Rewrite Drug Laws with Focus on Addiction Treatment

Legislators and other policy makers throughout the country continue their efforts to combat the drug epidemic in America, especially with regards to heroin and other opiates. For example, lawmakers in Washington are seeking to change the way the Evergreen State approaches treating opioid addiction. House Bill 2489 and its counterpart in the Senate would make significant changes to the state law to make medication-assisted therapy the treatment of choice for opioid addiction, according to reports.

Treatments for Opioid Dependency

Medication-assisted therapy is one type of treatment where people dependent on the drugs are prescribed substitute medications such as buprenorphine or methadone to keep withdrawal symptoms under control while providing supportive counseling and other services.

Many studies have shown that the incorporation of such medication can be beneficial, although most treatment specialists still recommend only short-term usage, as continuing to take the drugs for years results in its own dependency. However, used for stabilization and then a tapering process bolstered by intensive treatment can improve early relapse rates for many users.

Offering Many Forms of Treatment

The deputy chief medical officer for the Washington Health Care Authority, Charissa Fotinos, pointed out that updating the state treatment guidelines would help to put across the message that addiction is not a moral failing on the part of those affected. It may not encourage more people to seek help, but it will change the tone of the conversation for those who do reach out for assistance.

Opioid users themselves stated in a survey they were very interested in medications to help them reduce their drug use. They are interested in obtaining the most effective treatment for their addiction, according to the University of Washington’s Alcohol and Drug Abuse Institute, which conducted the survey of needle exchange clients.

The bill will change the current language, and it includes directions to expand access to treatment options across the state. Many of these expanded treatment provisions hinge on funding that will be provided in Governor Jay Inslee’s new budget.

The new bill and the funding would work together to create a “hub and spoke” treatment network in areas of Washington. Six pilot sites are operating in the western part of the state with federal funding received last fall.

Under this treatment model, clients are referred to a central hub to get started on their treatment. Once they are stabilized, they can get ongoing care, including counseling and medication, from a mobile provider or a clinic located closer to their home.

Buprenorphine for Addiction Treatment

States Expanding Access to Buprenorphine for Addiction Treatment

Buprenorphine for Addiction TreatmentThere continues to be a high demand for medication-assisted treatment (MAT) for opioid addiction. To date, however, states like Ohio only haveabout two percent of doctors that have completed the training necessary to prescribe or dispense buprenorphine. This is the main ingredient in the addiction treatment drug Suboxone, and other similar medications.

Plan to Double Healthcare Professionals Providing Buprenorphine

The state is planning to double the number of healthcare professionals certified to provide Suboxone (and other addiction treatment medications) to patients over the next 18 months. The federal government has provided $26 million in grant funding under the 21st Century Cares Act so that more healthcare providers can get training. Under existing law, doctors, as well as nurse practitioners and physician assistants (PAs) can dispense buprenorphine.

Waiver to Treat Patients for Opioid Addiction

Under the Drug Addiction Treatment Act of 2000 (Data 2000), doctors can apply for a waiver allowing them to treat patients with buprenorphine in their office, clinic, a community hospital or “any other setting where they are qualified to practice.” To qualify for a physician waiver, a doctor must be:

• Licensed under state law
• Registered with the DEA (Drug Enforcement Administration) to dispense controlled substances
• Agree to treat a maximum of 30 MAT patients during the first year
• Qualify to treat MAT patients, either by training or by professional certification

A doctor who has completed at least eight hours of classroom training focused on treating and managing patients with opioid use disorders can qualify for a waiver. The new training program for medical professionals is 1.5 days of classroom instruction, and participants are expected to continue their education through online courses and seminars.

Medication-Assisted Treatment Growing in the United States

The National Institutes of Health Studies says that MAT is a very effective method for treating opioid addiction. Studies conducted in 2014 revealed improved long-term recovery rates over traditional treatment methods, though it often takes finding the perfect balance for each individual as to how long they stay on the medication. Ideally, they would work toward being off of it in 2 years or less, and many people seek to use Suboxone for short-term tapering to simply ease opiate withdrawal symptoms.

Opioids for ER Patients

Over-the-Counter Pain Relievers as Effective as Opioids for ER Patients

For a number of patients, their first introduction to opioid pain medications occurs when they seek treatment in an Emergency Room (ER). Since doctors have more than one option for treating pain, what would happen if they offered over-the-counter pain medications instead of these strong, potentially addictive drugs instead?

A new study looked at what would happen if doctors took this approach to patients who visited the ER for treatment of sprains and broken bones. The results found that pain relievers sold under brand names as Tylenol and Motrin were as effective as opioids for treating severe pain.

Treating Acute Pain Without Opioids

The study involved 411 adult patients who sought treatment in two Emergency Rooms in New York City. All of them received ibuprofen (the main ingredient in Motrin) and acetaminophen (the main ingredient in Tylenol) or one of three opioid drugs: codeine, oxycodone or hydrocodone. All patients received standard doses, and none were told which medication was being administered.

The patients rated their pain levels on a score of 1-10 before being given their pain medication and again two hours later. The researchers found that for an average patient, the pain levels dropped from a 9/10 to approximately 5/10. There was little difference reported between the two groups.

Dr. Andrew Chang, Professor of Emergency Room Medicine at Albany Medical College in New York State, explained that ibuprofen and acetaminophen affect different pain receptors in the body. He went on to say that using them together may be especially effective.

These results dispute the standard ER practice used for treating acute pain. It could lead to changes that could help prevent new patients from being given opioids, which have such a high potential for abuse.

Although the study didn’t continue to follow the patients after they left the hospital, it is likely that the pain relief continued while taking the OTC remedies.

Study Has Potential to Help Opioid Crisis

Over two million people in the US are addicted to prescription painkillers or heroin. According to experts, changes in how ER doctors prescribe drugs could potentially put a dent in the current opioid crisis and help save lives.

Long-term opioid use often starts after patients are introduced to the drugs in an acute pain treatment situation. Emergency Rooms have given them to patients more often in recent years, although more states have limited the number of pills that can be given out. According to previous studies, approximately one-third of ER patients received an opioid painkiller during their visit. Approximately 20 percent of ER patients leave the hospital with a prescription for an opioid pain medication.

opioid epidemic

Addiction Expert Explains Three Main Groups of Opioid Epidemic

For the average person reading news stories or listening to the situation being discussed on the air, it seems as though the situation is mainly about young people who have moved from a prescription opioid dependency to a heroin addiction and that fentanyl is causing many of the overdose deaths. Popular news stories imply that efforts to stop people from becoming addicted to prescription drugs have not helped, but only made the issue worse.

This is one part of the opioid crisis but it isn’t the full story. As Andrew Kolodny, the co-director of opioid policy research at Brandeis University Heller School for Social Policy and Management pointed out, there are three opioid epidemics impacting North America.

The Three Opioid Epidemics in North America

1. Longtime Addicts

This, according to Kolodny, is the smallest group. Most of them are between the ages of 50-70 and started using heroin in the 1970s and 1980s. They lost a number of their friends to addiction. Fentanyl is responsible for killing off people in this group, due to the heroin supply being “laced” with this powerful pain reliever.

2. Young Rural and Suburban Users

The second group is the middle one, and is between 20-40 years of age. This is the group that gets most of the press coverage. They are people who are being found dead of an overdose, often with needles still in stuck in their arm.

In many instances, the road to addiction starts out with prescription opioids. The person may have started taking medications prescribed for someone else. They may have originally been prescribed the pain medication, but started using it more often than as directed. When their supply ran out, they turned to buying pills on the street.

At some point the cravings for pills increased. The cost was high and heroin could satisfy the cravings at a cheaper price. Switching from pills to heroin wasn’t anything new, according to Kolodny. Again, when dealers started adding fentanyl to their heroin supply around 2011 because it was a cheap filler, the number of overdose victims skyrocketed.

3. Middle-Aged and Senior Adults

The largest group, which has remained mostly under the popular press’ radar, is made up of people in their mid-40s through to their 80s. Their deaths due to opioid abuse are under-reported.

People in this age group may have been taking pain medications prescribed by their primary care doctors for several years. When they pass away from heart disease or another cause, no one wants to think of their long-term opioid use as being a contributing factor. Families also don’t think to ask whether their loved one may not have been using their opioid medication appropriately, whether there was an interaction with other medications (over the counter or herbal supplements included). They wouldn’t ask whether alcohol use and opioids may have been an issue.

The fact there are three sub-groups among this epidemic is why the number of overdose deaths have continued to rise. This isn’t a typical substance abuse problem, as the number of lives lost have actually reduced the average life expectancy in America.

To solve this problem Kolodny suggests investing money in building a new treatment system at an estimated cost of $60 billion. Although there are a ton of addiction programs doing great things, the system as a whole isn’t slowing the number of deaths, so more must be done.

injection treatment for opioid addiction

Monthly Injection Treatment for Opioid Addiction Approved by FDA

The FDA (US Food and Drug Administration) has approved a monthly treatment for addiction that is the first of its kind. The new option can be used for those struggling with substance abuse issues stemming from an addiction to narcotics such as prescription painkillers or heroin.

Sublocade, from Indivior Plc, is buprenorphine given by injection. The drug reduces the sensations of withdrawal symptoms in addiction patients. Administering the drug monthly could help patients comply to the treatment schedule, compared to other versions currently available such as daily oral doses in the form of pills or dissolving strips.

Effort to Reduce Stigmas Around Drugs

Approving the new drug treatment product is part of the Administration’s plan to reduce stigmas surrounding this class of medications. Buprenorphine is a synthetic opioid, and critics have expressed their opposition to medication assisted treatment (MAT). Instead, they favor changing users’ behavior to combat the current opioid crisis.

The FDA and other federal agencies are supporting MAT, which involves administering drugs and providing counseling to those affected. The White House referred to the situation as a “public health emergency” in October.

The FDA commissioner, Scott Gottlieb, released a statement recently that said the FDA is “committed to expanding access to treatments that can help people pursue lives of sobriety.”

New Medication Available Early in 2018

According to reports, Sublocade will be made available to patients early in 2018, according to Indivior. The National Institute on Drug Abuse reports that in 2016, drug overdoses were responsible for taking the lives of more than 64,000 Americans. This figure includes overdoses caused by prescription drugs, such as fentanyl and OxyContin, and illicit ones like heroin. Clients who receive medication assisted treatment for drug addiction reduce their risk of death from all causes in half, according to the FDA, making this option a valuable one.

Mr Gottlieb stated that the FDA is currently working on guidelines that will get further treatment options for treating opioid addiction into the market more rapidly.

nerve stimulator for opioid withdrawal

FDA Approves Nerve Stimulator for Opioid Withdrawal

The Food and Drug Administration (FDA) has given its approval for a specialized tool that will be used to help US patients addicted to prescription pain medications and get them off opioids.

The newly-approved device delivers electric pulses to the area behind the patient’s ear. This electric pulse triggers a current which travels to the person’s occipital nerves (the ones reaching from the spinal cord to the back of the neck) and cranial nerves. It functions as a PNFS (Percutaneous Nerve Field Stimulator) device system and stimulates the patient’s brain to mask opioid withdrawal symptoms.

This medical device has been named the NSS-2 Bridge (NSS stands for “Neurostimulation System”.) Research shows that when used over a five-day treatment period, the process can be effective. The device is used during the period when an opiate-dependent person is likely to experience the most intense pain, as well as body tremors and sweating, during withdrawal.

Seventy-three patients were involved in the trials to determine the device’s effectiveness. Close to one-third (31 percent) of the participants noticed a reduction in symptoms within half an hour of getting the device. The trial found that 64 of the patients got relief and were ready to move forward to medication-assisted therapy after using the device. This represented a success rate of 88 percent after the five-day trial. However, other applications may include permanent abstinence rather than switching to a maintenance drug.

The FDA has decided to approve the device, even though the results of the study are limited. Further trials will be undertaken to evaluate its effectiveness in various settings.

FDA Commissioner Scott Gottlieb stated in his reasons for approving the new device that there is a need for finding new ways of helping people who are addicted so that they can achieve sobriety with “medically assisted treatment.” He went on to say that while research is continuing to find better medicines to treat opioid use disorder, medicine also needs to look to devices to help as well.

Finding alternative methods of treating opioid dependency is a major topic of discussion regarding dealing the epidemic our nation faces. In addition to helping people get off these drugs, it is imperative to find more ways to reduce or avoid using these highly addictive substances.

recognize opioid overdose

How to Recognize an Opioid Overdose

Recognizing an Overdose Early Can Save a Life

It is a sad but true fact that opiate addiction has been steadily on the rise since the early 2000s. This means that the rates of overdose have also been steadily climbing. In fact, the problem has become so widespread that law enforcement and medical professionals are labeling it an epidemic. Without the proper tools to recognize opioid overdose, a person abusing heroin or prescription pain meds can die or experience irreversible damage.

The World Health Organization estimates that at least 69,000 people across the globe die from opiate overdoses each year. To help curb this number, we believe it is important that everyone is educated about this class of drugs as well as the symptoms and how to help someone who may be experiencing an overdose. Continue reading to find out how opioids affect a person, how to recognize opioid overdose, and what steps to take to help save someone’s life. 

What is an Opioid?

Opioids are a category of painkillers that include well-known drugs such as heroin, morphine, OxyContin, Vicodin, methadone and tramadol. Due to the nature of these drugs, it is easy to become dependent on them if a person is not under careful medical supervision.

Most often, these types of drugs are given to people who have serious surgeries, significant injuries or chronic pain, but substances like heroin are most often introduced on the streets, sometimes when a person is unable to get more of their prescribed opioids.

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recognize opioid overdhose

How Do Opioids Affect a Person?

Opiates bind to certain receptors in the brain that help to block pain signals and make the user feel relaxed. When used in a managed setting, they are excellent tools for people who suffer from intense pain.

Issues arise when people take too much at once or begin to use the drugs as a way to escape from real life.

How to Recognize an Opioid Overdose

There are several telltale signs that a person is experiencing an opioid overdose.

Physical signs include:

  • Slowed breathing
  • Bluish tint around fingernails or lips
  • Pinpoint pupils
  • Vomiting or painful constipation
  • Inability to be woken from sleep
  • Slow or irregular heartbeat
  • Cold or clammy skin
  • Unusual paleness
  • Extreme mood swings
  • Confusion or drunken behavior

If you encounter someone with these symptoms, it is critical to contact emergency medical services right away because the person’s life is in immediate danger. Opiate overdoses can kill a person quickly, so every moment counts.

How to Help Someone Who Has Overdosed

Though you should immediately call 911 when you recognize an overdose, there are steps you can take to assist the person until help arrives.

If the person is unconscious, roll him or her to one side. This helps prevent people from choking if they vomit while unconscious. If the person is still conscious, do your best to keep the person talking to you and don’t let him or her fall asleep. Because these drugs slow breathing functions, allowing an overdosed person to fall asleep can lead to cessation of breathing.

Don’t leave the person alone if you can help it. A conscious person will be delirious and can easily get into a dangerous situation, and an unconscious person may stop breathing. If left unattended, you won’t be able to administer rescue breathing if necessary.

There is also a treatment for these overdoses called naloxone. This is something that emergency rooms have used for many years to help reverse these types of overdoses, especially heroin-related ones. Due to the dramatic increase in overdose deaths, however, it is now common for emergency medical personnel and even caregivers to carry naloxone with them.

Naloxone comes in nasal spray and injectable forms and can give the overdosed person up to an hour’s respite from overdose symptoms. This does not stop the overdose permanently, so it is still important to call emergency responders to give the person lifesaving medical treatment. In addition, following an overdose, the person will likely require some sort of opioid addiction treatment to ensure that they don’t use heroin or other opioids again once they have recovered from the overdose.

Encountering an opioid overdose can be a frightening experience, but learning how to recognize the signs and give assistance can save lives.

Opioid Epidemic

Fentanyl’s Role in Opioid Epidemic

Study Confirms Fentanyl’s Role in Opioid Epidemic

The fentanyl epidemic in the United States is growing by the day, but because it is a relatively new additive, there is little research to compare the current situation with history. However, a recent study conducted by researchers at Boonshoft School of Medicine Center for Interventions, Treatment, and Addictions Research (CITAR) at Wright State University provides more concrete evidence about the fentanyl problem in this country. This is important because in order to reduce the number of people who ingest this powerful drug, there needs to be evidence of its growth and education about what fentanyl is and how to avoid its use.

What is Fentanyl and Why is it So Dangerous?

Fentanyl is a pharmaceutical drug that is 50 to 100 times more powerful than morphine. Most commonly, the drug is prescribed to cancer patients, but is also given in hospital settings to combat major pain issues. Regarding abuse, fentanyl has gained popularity with drug dealers because of increased potency when it is combined with heroin. Due to inadequate testing procedures, many experts believe that a greater number of overdose fatalities involved fentanyl than previously reported.

Heroin dealers are now mixing fentanyl into the supply in order to create a stronger, more intense high and to increase profits. But, because of this new combination, more addicts are suffering from fatal overdoses. Other studies have shown that most opioid users are not aware that they are ingesting fentanyl, and actively try to stay away from the drug in an effort to avoid these types of overdoses. This goes against the suggestion that addicts will seek out fentanyl in order to get a stronger high. Further research has shown that many drug dealers are getting their hands on fentanyl not from legitimate hospitals or doctors, but from illegal labs that have mimicked the recipe.

“The findings of our study highlight the urgent need to include testing for fentanyl and fentanyl analogs as a part of standard toxicology panels for biological specimens used by substance abuse treatment centers, criminal justice institutions and medical providers. Communities also need to assure that sufficient supplies of naloxone doses are provided to first responders and distributed through community overdose prevention programs to mitigate the effects of opioid overdoses,” explained lead author of the study, Raminta Daniulaityte.

Long-Term Impact of Fentanyl 

While there are still more long-term studies that need to be conducted on the fentanyl problem, this is a step forward for medical professionals who are looking to educate addicts and the public on the dangers and prevalence of the drug.