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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.

medically supervised detox

The Importance of Medically Supervised Detox

The Importance of Medically Supervised Detox

When an addiction sufferer realizes they have a drug or alcohol problem, the decision to stop using is a tremendous first step. However, for a number of reasons sufferers may choose to attempt the detoxification process by themselves.

Drug or alcohol addicts may be ashamed of their use, afraid to share their addiction, or simply may not know where to turn. Unfortunately going through detoxification alone may be more detrimental to the long-term health of the sufferer than not coming clean in the first place.

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importance medically supervised detox

Physical Withdrawal from Drugs or Alcohol

The sickness and physical pain caused by withdrawal symptoms often get the better of those attempting to self-detox. The body has become accustomed to functioning with the addictive substance. Organs and the brain have figured out ways to accommodate and flush toxic chemicals from the body.

But, once the addictive substance has been removed, the body doesn’t adjust as quickly. This results in unpleasant physical side effects including:

  • Nausea
  • Tremors
  • Diarrhea
  • Dizziness
  • Headache
  • Stomach Pain
  • Rapid heartbeat
  • Feeling lightheaded

In the most severe cases, seizures, heart palpitations, and other life-threatening conditions can occur. The possibility of withdrawal resulting in permanent health issues or even death should be reason enough to see medically supervised detox.

With medical supervision and intervention, physicians may be able to introduce medications which can assist in reducing physical symptoms. Fear of replacing one drug with another should be eased. Medically supervised detox can require daily or even weekly supervision. Thus reducing the unlikely development of a secondary addiction.

Mental Obstacles in Detox from Drugs

Patients seeking to detox should not only seek out medical solutions but, mental and therapeutic support. While the physical discomfort of withdrawal can be severe, in some instances the mental anguish associated with withdrawal can become too much to bear for some individuals.

During the detox process, suffers can experience mental symptoms including:

  • Anxiety
  • Depression
  • Nightmares
  • Sleeplessness
  • Feeling of hopelessness
  • Intense desire to use again

Detoxifying can be a psychologically taking ordeal. Having access to the proper level of both medical and mental therapeutic support significantly increase the chances for success.

The Benefits of Medically Supervised Detox

The detox process is similar to other medical treatments. First, the addiction is identified and evaluated. Once understood, the proper treatment plan can be put in place. Finally, and perhaps most important, follow up treatment and assessments help ensure a successful recovery.

Medically supervised detox provides the same benefits as other treatments, such as physical therapy or surgery including:

  • Professional medical and therapeutic staff
  • Clean, safe, and supportive environments
  • Expert symptom relief

Physicians and nurses specially trained in addiction-related treatments can alleviate withdrawal symptoms. They also know when to intervene in an emergency or when to change course if outcomes are not meeting expectations.

Rehabilitation and recovery centers provide a safe environment for sufferers. Surrounded by knowledgeable staff at all levels, comfort and privacy are provided for even the most vulnerable moments of the detox process.

What to Expect During Detox

One of the first questions asked is how long an average detox program can last. There are several factors which determine how long addiction sufferers may spend in a program:

  • Frequency of use
  • Underlying medical conditions
  • Use of single or multiple substances
  • How long drugs or alcohol have been abused

Typical stays last from a few days to a couple weeks. Keep in mind this is only the inpatient treatment portion of the program. Participants will be expected to make regular physician visits and are encouraged to commit to therapy sessions or support groups.

During the time at the rehabilitation center, expect to be surrounded by around the clock care from doctors, nurses, and therapists. Upon entering the center, physicians will establish a medical baseline of health and uncover any medical conditions you may have.

With around the clock monitoring, vitals are checked on a regular basis. As much rest as needed is provided. Each day medications are adjusted appropriately to assist in the detox process. Ultimately the goal is to get addicted suffers back to being themselves as soon as possible.

After Detox

In most instances, it is recommended clients seek continued monitoring. In addition to returning home with the support of friends and family, after detox treatment programs greatly reduce the chance of relapse.

As supportive as friends and family may be, trained professionals can help with unique physical and mental after-effects addiction sufferers may experience. The support in treatment programs provides a source of comfort while adjusting to sober living.

The importance of medical supervision during the detox process cannot be stressed enough. Medically supervised detox is the safest and best step anyone can take to rescue their life from addiction.  If you or someone you know requires detox, there are many organizations including Desert Cove Recovery who can provide the best possible detox options.

length of opioid prescription

Length of Opioid Prescriptions and Opioid Addiction

Length of Opioid Prescriptions and Opioid Addiction

Every day, people who were only seeking a little pain relief unwittingly become addicted to opioids.

Most get prescriptions from their doctors following surgery or an injury. Many seek relief for ongoing back pain. Some borrow pills from friends just to take the edge off after a stressful day at work. None ever plan on getting hooked.

In 2016, 66% of all fatal drug overdoses in the U.S. involved an opioid. What was only an area of concern in the late ‘90s is now a full-blown crisis.

If you’re worried about your opioid habit, you may have reached out to us just in time. Keep reading to find out how your lawmakers and the professional caregivers at Desert Cove Recovery can help you.

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Limiting the Length of Opioid Prescription

In an effort to stop this epidemic, mental health experts and politicians want to limit the number of doses that patients can get at one time. Several states have passed laws on prescription lengths. The CVS pharmacy chain recently announced that it will only dispense seven days’ worth of opioids at a time.

The idea behind shorter prescriptions is to take unnecessary pills out of circulation. Limiting doses will result in less potential for abuse. Even people who use painkillers responsibly fail to properly dispose of the extras; stockpiles in home medicine cabinets are tempting.

Finding the magic number is no easy task. In the Centers for Disease Control and Prevention guidelines, the recommended length of opioid prescription is three to seven days. Some experts challenge those numbers, pointing out that they are far too conservative for major surgeries like hysterectomies. They also argue that unreasonably short prescriptions will only prompt patients to get refills.

There’s no easy fix, but the opioid addiction crisis has everyone’s attention. That’s a good thing.

Understanding Opioid Addiction

Prescription opioids are closely related to morphine, codeine and heroin. Commonly used opioids include methadone, hydrocodone and fentanyl. One of the most frequently prescribed remedies, oxycodone, is twice as powerful as morphine.

Synthetic opioids attach to receptors in the brain so that your perception of pain is altered. If you have a legitimate need for them on a short-term basis, they’re a godsend. However, they have great potential for becoming addictive. 

Synthetic Opioids are Addictive

Dopamine is a natural feel-good chemical that gives you a warm sense of pleasure and reward when you’re enjoying yourself. In mentally healthy people, it’s always at just the right dose.

In addition to relieving pain, opioids signal your brain to increase production of dopamine. The excess might result in a rush of intense euphoria. There’s a severe letdown when the sensation wears off.

People become addicted to opioids when they try to duplicate that initial high by increasing the dose or combining pills with other drugs like alcohol. The body quickly builds tolerance, and the vicious cycle of addiction begins.

That’s why lawmakers are so concerned about doctors over-prescribing painkillers. The practice results in millions of loose pills being abused or falling into the wrong hands.

Are You Addicted?

You may have an opioid addiction if you’ve experienced even one of these symptoms:

  • Taking opioids after your pain has subsided
  • Taking higher doses than prescribed
  • Taking opioids that aren’t prescribed to you
  • Trying without success to stop
  • Using opioids recreationally
  • Combining opioids with other substances
  • Craving opioids when you’re not using them
  • Lying about opioid use
  • Becoming defensive when friends or family members express concern
  • Sleeping during waking hours
  • Experiencing irritability, mood swings or depression

Your chances of becoming addicted are significantly higher if you have a mental problem such as depression, anxiety or eating disorder. You’re also at greater risk if anyone in your family struggles with substance abuse. Traumatic events in your past, like divorce, domestic violence or rape, will also make you more susceptible to opioid addiction.

Getting Help for Addiction

Substance abuse can start with one bad decision, but after that, the painkillers take over. Like other drugs, they teach your brain to crave them.

Drug addiction is a chronic disease with no cure, but it can be managed just like asthma or diabetes can. Just as people become addicted every day, people start to recover every day.

Choosing Desert Cove Recovery for Help With Opioid Addiction

Our caregivers at Desert Cove Recovery have years of experience with people just like you. Our comprehensive treatment plans utilize time-tested approaches that help recovering addicts stay clean for good:

  • The 12-step model
  • Cognitive behavioral therapy
  • Individual and family counseling
  • Group meetings
  • Holistic approaches such as prayer, meditation, yoga, art, music or massage
  • Exercise classes and outdoor activities
  • Nutritional instruction

With professional help, you can break free from the grip of opiate addiction. Call Desert Cove Recovery today to speak with a caring counselor. We’ll tailor a unique treatment plan that’s just right for you.

 

 

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.

U.S. Dept. of Health Continues Fight Against Opioid Addiction

painkillersThe United States Department of Health and Human Services (HHS) announced earlier this month new efforts to make an impact on the opioid problem in America. There were three main areas of focus included in this announcement, which were improving prescribing practices, increasing access to medication-assisted treatment and making naloxone more widely available for emergencies.

With this came what many consider the big news that doctors who are approved to prescribe buprenorphine have been able to more than double the number of people they can treat at a time. They were previously limited to 100 patients, but the Substance Abuse and Mental Health Services Administration (SAMHSA) just raised that cap to 275 patients.

Secretary of Health and Human Services Sylvia Burwell stated, “The opioid epidemic is one of the most pressing public health issues in the United States. More Americans now die from drug overdoses than car crashes, and these overdoses have hit families from every walk of life and across our entire nation. At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention.”

The part that seems to stand out as having the greatest overall impact is the changing of prescribing practices by doctors who give out painkillers. Opiates have been too heavily relied on to treat various pain conditions, while at the same time underestimating their abuse and addiction potential, and a major overhaul is sorely needed.

In the meantime, wider availability and use of medications that like naloxone and buprenorphine can help to reduce the damage caused by painkillers and other opiates so that there is a better chance at rehabilitation. Most people want, and deserve, long-term fixes for opioid problems rather than temporary patches.

If you or someone you love has a problem with painkillers, heroin or any other type of drug, contact Desert Cove Recovery today to see how we can help.

More Pharmacies Offering Naloxone Without a Prescription

naloxone formulaBig news hit recently when CVS drug store became the first pharmacy to announce that they were going to be offering naloxone for sale without a prescription. The opioid overdose problem has gotten so bad that this life-saving drug is now available direct to consumers in some areas.

Kroger, one of the nation’s largest supermarket chains, also just announced that they would be making naloxone available to the general public through its pharmacies as well. “This marks an important step in our fight to combat addiction and we all need to continue to work for a bottom-up, comprehensive approach to the heroin epidemic,” said U.S. Senator Rob Portman, (R) OH.

While the drug isn’t available over the counter everywhere yet, states like Ohio and Kentucky, where the per capita opioid overdose rates are even higher, have been more eager to act on providing additional palliative measures for the epidemic. Legislators, law enforcement officials and other community leaders are coming together to try and address the problem from multiple sides.

While making naloxone available over the counter directly to the public will certainly help save many lives from overdose, it is only the tip of the iceberg in terms of the amount of action and effort needed to reverse the opiate abuse trend throughout the United States. Yes, each bit helps, but perhaps investing in more treatment infrastructure will make the most sense long term in addition to amped up prevention programs.

Nonetheless, having tens of thousands of people die each year from an overdose on heroin or prescription painkillers is unacceptable, and it will take more forward thinkers to develop other initiatives to made headway against this scourge.

CVS Pharmacy to Offer Naloxone Without a Prescription in Multiple States

nalxIt appears that CVS pharmacy chain is continuing to trail blaze in its commitment to advocating for better health conditions in the United States. They recently took a giant step by announcing that they were going to stop selling cigarettes in their stores, and now they have just announced that they are expanding their offering of the life-saving drug naloxone.

Naloxone is typically only available by prescription, but CVS is making it accessible to consumers without a prescription in 15 states, including Arkansas, California, Massachusetts, Minnesota, Mississippi, Montana, New Jersey, North Dakota, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah and Wisconsin.

With the drastic increase in opioid-related overdose deaths in the United States tied to drugs like narcotic painkillers and heroin, many officials throughout different parts of the country have advocated for making naloxone more available to people to help prevent casualties.

“Over 44,000 people die from accidental drug overdoses every year in the United States and most of those deaths are from opioids, including controlled substance pain medication and illegal drugs such as heroin. Naloxone is a safe and effective antidote to opioid overdoses and by providing access to this medication in our pharmacies without a prescription in more states, we can help save lives,” said Tom Davis, RPh, Vice President of Pharmacy Professional Practices at CVS/pharmacy. “While all 7,800 CVS/pharmacy stores nationwide can continue to order and dispense naloxone when a prescription is presented, we support expanding naloxone availability without a prescription and are reviewing opportunities to do so in other states.”

The pharmacy chain has also expanded its support of prescription drug take-back programs by providing more collection kits to local law enforcement and assisting in DEA-sponsored events.

The White House Plan for Opiate Addiction

President Obama has explained how he wants to make a dent in the amount of prescription drug abuse in our country recently. In order to lower the amount of people addicted to drugs like Oxycontin, Vicodin, Percocet and heroin, the Administration has three main issues that it wants to address.

One of the areas is to repordedly put a greater focus on prescription monitoring drug tools. He wants to put more money towards improving and adding additional drug treatment programs around the country and he wants to explore making drugs like naloxone more available throughout the country to first responders and families with heroin addicts.

Prescription monitoring tools are essential to thwarting an addict’s attempt at obtaining medications illegally. These programs allow doctors, pharmacists and law enforcement to keep a better eye on painkiller prescriptions. For those with access to the program, they can see who is prescribed what, by whom and where they are filling their prescriptions. They also allow doctors to see if their patient has recently been to another doctor and obtained a prescription for opiates. Oftentimes, in order to evade suspicion, addicts will fill their prescriptions at different pharmacies. This tool would allow pharmacists to see if the person had recently filled the same prescription somewhere else. Many states have invested money in instituting a prescription monitoring program, however not everyone uses the tool, which essentially renders it ineffective. Obama wants to put more of a focus on getting these programs running and actually used everywhere.

More than $100 million in additional funding is being requested to fighting the drug abuse problem. Part of that money would be given to rehabilitation centers and states that need to establish more treatment beds. Many addicts have a difficult time enrolling in treatment because of the long wait lists at publicly-supported rehabilitation facilities. Creating more beds would allow greater access to treatment for people in need of help.

Naloxone is a drug that, when administered, reverses the effects of an opiate overdose. Currently some states have allowed their law enforcement officers and emergency medical personnel to carry around prescriptions of the drug to administer if they are first on the scene of an overdose. Obama wants to explore this further and potentially make carrying naloxone a national thing, rather than just a few states.

Naloxone-Carrying First Responders Are Saving Lives

nasalnarcanFirst responders in Quincy, Massachusetts have been trained to administer Narcan (a brand of naloxone) to people who have overdosed on opiate narcotics such as heroin, methadone and prescription painkillers. These paramedics and police officers have been able to save many lives, according to a news report.

Every police cruiser in the down is now equipped with two doses of nasal Narcan. Since they started carrying the doses, officers have used it successfully 170 out of 179 times over the past three years. The article notes that of the remaining nine, five of the people had already passed away before it was administered and the other four had used multiple substances.

Overdose deaths from opiates have increased exponentially across the country and reached nearly 20,000 per year, which is more than the number of lives lost to AIDS or homicides.

Providing safety measures such as making naloxone available to first responders nationwide could potentially help save thousands of lives per year. While this by no means is enough, many advocates, treatment professionals and policy makers feel that it is important to use as many tools as possible to prevent the loss of life through substance abuse.

Opiate users often seek treatment after an overdose, which should halt the drug use if the right program is matched up to the individual. If you know of someone in need of treatment for heroin addiction, painkillers or any other type of drug, contact us today.