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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.

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.

Pain Relief Without Fear of Addiction

Compound May Offer Pain Relief Without Fear of Addiction

New research from Indiana University-Bloomington may give doctors and their patients living with pain a non-opioid option for treating severe pain.

Researchers conducted a pre-clinical study involving mice. They discovered that compounds known as PAMs (Positive Allosteric Modulators) heighten the effect of natural pain relievers the body produces internally when injured or exposed to stress. PAMs were first discussed with attendees at the 2016 Conference for the Society for Neuroscience, held in San Diego, California.

About PAM

The researchers chose a PAM that would intensify endocannabinoids. These two brain compounds (anandamide and 2-arachidonoylglycerol) specifically act on the CB1 receptor that responds to the presence of THC, the main psychoactive ingredient in marijuana. The PAM used in the study was GAT211, a molecule that coauthor Ganesh Thakur at Northeastern University created that had effects that concentrated on the brain.

The PAM increased the effects of the endocannabinoids without creating the undesired side effects associated with marijuana use. These include lowering of body temperature and clumsiness.

The pain relief achieved from PAM was more effective and lasted longer than when drugs were used that work by breaking down then metabolizing the brain’s cannabis-type compounds. Using PAM on its own means natural painkillers target the correct part of the brain as needed. The alternative is take drugs that bind to receptor sites throughout the body.

Increases the Body’s Natural Ability to Relieve Pain

Study leader Andrea G. Hohmann, a professor and chair of neuroscience at the University’s Department of Psychology and Brain Sciences, stated that the study revealed a PAM increases the body’s pain relieving ability without decreasing effectiveness over time. This is a key component of addiction; a person finds that they need to consume more of their drug of choice to experience the desired effect.

Professor Hohmann went on to say that she sees the research her team is doing as “an important step forward” in the goal to find new, non-addictive pain relievers.

The results of the study were published in the journal Biological Psychiatry.

Non-Addictive Painkillers Help Save Lives from Opioid Overdose

Continuing to find ways of providing pain relief for patients that don’t involve drugs with a high potential for abuse is of utmost importance in the battle against opioid addiction. Tens of thousands of lives are now lost each year due to overdoses and millions of people are abusing these drugs.

If you have a loved one who needs treatment help for a substance abuse problem, contact Desert Cove today for more information about our program.

high sugar diet and opioid addiction

Research Indicates Link Between High Sugar Diet and Opioid Addiction

New research from the laboratory of behavioral neuroscience at the University of Guelph has suggested a possible link between diet and risk of opioid addiction. Specifically, children and adults may be more vulnerable to opioid addiction when high amounts of refined sugars are consumed.

There has been a lot of press recently about the current opioid crisis — and for good reason. The Centers for Disease Control and Prevention (CDC) reports that provisional counts for the number of deaths has increased by 21 percent in the period 2015-2016. Drug overdoses are now claiming lives at double the rate of motor vehicle accidents and firearms combined.

Sugar Activates Reward Centers in Brain

Research studies have revealed that refined sugar activates the reward centers in the brain in the same manner as addictive drugs. Opioid abuse has also been linked to poor diet, including a preference for foods that are high in sugar. Based on this link, researchers had questions about whether there was a connection between a diet with an excessive amount of refined sugar and an increased susceptibility to opioid addiction.

How Research Was Conducted

The research team looked at whether an unlimited level of access to high fructose corn syrup changed laboratory rats’ behavior and responses to oxycodone, a semi-synthetic opioid. High fructose corn syrup, a commonly used food additive in North American processed foods and soft drinks, was selected for this study.

In one study conducted by doctoral student Meenu Minhas, the rats were given unrestricted access to drinking water sweetened with high fructose corn syrup. The sweetened water was removed after about a month. After a few days where the rats didn’t have access to any sweetened water, researchers evaluated the rats’ response to oxycodone.

The researchers found that when the rats consumed high levels of corn syrup, they may experience less rewards from the oxycodone. As a result, the rats may be looking to take higher amounts of the drug.

High Sugar Diet May Contribute to Opioid Addiction

The results indicate that a diet high in sugar may dampen the pleasure that someone may get from taking drugs such as Percocet, Percodan, and OxyContin at lower doses. Since these sedative drugs normally make a user feel more relaxed shortly after being ingested, someone who isn’t getting these results is likely to take a larger dose to get the desired results.

Higher doses of sedatives and painkillers can be dangerous. At high levels, they can interfere with central nervous functioning and slow down breathing, leading to coma or respiratory arrest. When combined with alcohol, their effects multiply since alcohol is also a depressant drug.

This research is another good reason to eat a balanced diet, including lean meats, fruits and vegetables, whole grains and low-fat dairy products. There is a place for sweets, but in moderation.

Heroin Affecting Newborns in Record Numbers

One of the most dangerous things about heroin is that it can impede a mother’s instinct to protect her child. This is most evident in the number of children being born addicted to heroin. This addiction occurs when mothers continue to use the drug while pregnant, causing their babies to be born dependent on the opiate, and needing to go through excruciating withdrawal symptoms in their first days of life. The number of infants born addicted to opiates continues to rise, as the heroin epidemic rages on in rural and urban communities.

While this problem is occurring throughout the country, it appears that rural areas are seeing a higher percentage of these tragedies than in cities. This may be because there is less access to quality treatment in rural areas, or drug education is not as evolved as it is in the cities. According to a University of Michigan study, heroin addicted babies increased four times in cities, while rural areas reported an increase of seven times. The results were published in the journal JAMA Pediatrics.

One reason why it is so difficult for expectant mothers to cease heroin use when they find out they are pregnant is because of the painful withdrawal symptoms they have to go through. Heroin addicts who stop using the drug experience insomnia, body aches, vomiting, paranoia, anxiety, depression, flu-like symptoms and intense cravings. These symptoms are so extreme that many in the medical profession strongly advocate for medical assistance when it comes to withdrawing from heroin. And while these are extreme symptoms for an adult, they are even more intense for an infant. Medical staff has to monitor the child constantly and watch as the baby goes through a withdrawal that most adults avoid at all costs.

“In the worst-case scenario, some of these babies die, and there’s a higher rate of mortality in this population. Later in life, there may possibly be issues with attention, but more research is really needed to understand the long-term effects,” explained Dr. Nicole Villapiano of University of Michigan Mott Children’s Hospital. Most babies who are born addicted to heroin exhibit increased irritability, tremors, inability or lack of desire to consume food, seizures and respiratory distress.

However, there are very few treatments approved for opiate-addicted mothers because of the potential damage caused to the unborn child during withdrawal. Unfortunately, the most common treatment includes putting the mothers on buprenorphine or methadone – both of which are synthetic opioids and can still cause the baby to have to go through agony after birth.

Researchers hope that this study will not only educate people on the dangers of using heroin while pregnant, but will also shed a light on the necessity of increasing education and prevention efforts in rural areas of the country. It also expresses a need for better treatment methods for mothers so that their newborns do not have to go through withdrawal.