The opioid epidemic continues to rage through North America, and experts in East Tennessee are looking into the source of the problem. Many of them have determined that it can start with a trip to the dentist’s office.
Dr. Turner Emery, an oral surgeon on Knoxville, explained that doctors have been blamed for a lot of patients getting started on opioids. However, dentists also prescribe this class of medications to their patients, who are also put at risk for addiction.
Exparel Given at Time of Surgery
Dr. Emery is using a medication in his practice called Exparel to reduce risk of opioid addiction. It numbs the area around teeth that have been extracted for up to four days after oral surgery has been performed. When Exparel is used, a dental surgery patient may not need prescription pain medication at all.
The peak time for a dental patient to experience pain following wisdom teeth removal is on the second and third day following surgery, Dr. Emery explains. He has had a couple of patients who have had to take one or two doses of a narcotic, but most patients have been able to relieve their pain wth over the counter (OTC) medicines.
The medication is given by injection in each molar. Patients report that it reduces the need for narcotic pain medication and doesn’t make them feel drowsy during the first few days following their procedure.
First Exposure to Narcotics After Dental Surgery
A number of adolescents are first exposed to opioids following dental surgery. They may also be prescribed these strong pain medications following a sport injury. If a young person is prescribed more medicine than they need for the initial health condition, there is a concern that the opioid pain reliever may end up in someone else’s hands. The young person may continue taking the narcotic after the initial need for the strong pain medication has ended.
Medication Effective for Pain Relief
Exparel isn’t covered by all health insurance companies. The medication costs approximately $200.00, which can be a prohibitive factor for some patients and their families. Dr. Emery states that the medication works “really, really well” and that he has had good results with it.
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.
Opiates are addictive in part because they activate parts of the brain associated with pleasure. However, that is only part of the story. A person who takes painkillers or other opioids will find themselves chemically dependent on the drugs. Once this happens, overcoming addiction can be extremely difficult. The physical and emotional withdrawal symptoms pose a tremendous challenge to individuals looking for recovery.
How Opioids Work in the Brain
Your body naturally produces opioids, which attach to special receptors in the brain. These neurotransmitters help the body naturally regulate pain and stress.
Chemical opioids attach to the same receptors in the brain and have a similar effect of producing euphoria. However, they are significantly stronger than anything the body can produce on its own. These fake neurotransmitters flood the system and eventually prevent the body from producing opioids of its own. Part of what causes drug withdrawal symptoms is this lack of dopamine and related chemicals in the brain as the body adjusts to the absence of opioids.
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Stages of Opiate Withdrawal: A Timeline
Drug withdrawal presents a set of physical and emotional symptoms that can be extremely difficult to endure. However, it’s important to remember that withdrawal is temporary.
If you or a loved one is facing detoxification and rehab, know that the worst of the symptoms will last just a few days. Knowing what to expect and having a timeline of events in mind can help to ease some of the psychological pressure when facing withdrawal and recovery.
Withdrawal symptoms for short-acting opiates will begin within 12 hours of the last dose. For long-acting opiates, symptoms may start within 30 hours. Over the next two days, symptoms will continue to worsen, peaking around the 72 hour mark. By the end of the third day, most physical symptoms will have resolved. Psychological symptoms and cravings may continue for a week or more.
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Early withdrawal symptoms include the following:
Agitation or anxiety
Sweats and fever
Increased blood pressure and heart rate
These initial symptoms may cause restlessness and mood swings.
The later stage of withdrawal produces flu-like symptoms:
Nausea, vomiting or diarrhea
Goosebumps and shivering
Stomach cramps and pain
Depression and intense drug cravings may accompany this stage. These symptoms will generally peak within 72 hours and resolve within five days. From a physical standpoint, recovery is well underway. Physical symptoms of withdrawal may disappear quickly after the third day of detox. However, psychological symptoms may linger, and drug cravings may persist or come and go in the weeks and months that follow.
What About Drug Replacement?
In some cases, an alternative substance like Suboxone may be provided to help mitigate the effects of chemical dependence. This drug is classified as a “partial opioid agonist,” which means that it is a weaker type of opioid that cannot be abused. Other replacement drugs, like methadone, may also sometimes be used.
Addiction clinics and rehab facilities offer these medications as a stepping stone to help reduce the severity of drug withdrawal symptoms. However, users will still undergo withdrawal when weaning off of the replacement drug, and recovery will take longer when these medical aids are offered. There is also the risk of finding a way to abuse these medications.
The Importance of Support During Withdrawal
Drug detox and addiction recovery services are crucial to helping people recover safely throughout the stages of opiate withdrawal and stay away from drugs long-term.
One important but often overlooked symptom of withdrawal is suicidal ideation. Not everyone who undergoes withdrawal feels suicidal, but the feelings of depression can be overwhelming. People in the grip of withdrawal may experience mood swings and dark thoughts that seem to have no end point. The feeling that life may never be better than it is in that dark moment or that the addict can never be happy again without drugs can be overwhelming. For this reason, a strong support system is essential to the safety of people overcoming addiction. Recovering addicts need to know that their symptoms are temporary. They also need to be protected from opportunities for self-harm and relapse.
Protecting recovering addicts from relapse is especially important because many deadly overdoses occur during relapse. Because the user’s body is no longer accustomed to the drug, it will be more sensitive. What would have been a normal dose for the user before withdrawal can become a deadly overdose in the weeks that follow.
The best drug rehabilitation programs provide a strong support network for recovering addicts throughout all stages of recovery, including the difficult weeks that follow acute drug withdrawal. By continuing to offer support after the initial symptoms have faded, the rehab program can provide the best environment for successful and permanent drug cessation.