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.
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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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.