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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.

stages of opiate withdrawal

Stages of Opiate Withdrawal

Stages of Opiate Withdrawal

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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stages of opioid withdrawal

Early withdrawal symptoms include the following:

  • Drug cravings
  • Agitation or anxiety
  • Muscle aches
  • Sweats and fever
  • Increased blood pressure and heart rate
  • Sleep disruption

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.

opiates and alcohol

Why Opiates and Alcohol are Such a Deadly Combination for Arizona Drug Users

Overdosing From Combining Opiates and Alcohol Is a Real Risk 

Media reports frequently focus on cases of opiate use, with Governor Doug Ducey even declaring a state of emergency due to the sharp rise in opioid overdose among Arizona drug users. However, little attention was given to the dangers of mixing opiates and alcohol until news reports emerged that Cory Monteith’s death was caused by combined drug intoxication from champagne and heroin which shed light on the deadly drug combination of opiates and alcohol. Although under-reported, over 70 percent of opiate-related deaths involve the use of another substance, and alcohol is present in more than 50 percent of opiate fatalities. 

Alcohol Is a Depressant 

Alcohol‘s ability to pass the blood-brain barrier allows it direct access to the GABA receptors and neurotransmitters of the central nervous system. These neurotransmitters are responsible for sending messages from the brain to every part of the body, including the limbs, muscles and organs. Alcohol blocks the nerve receptors’ messages, slowing down the central nervous system. As a result, bodily functions are altered. Changes in the body from alcohol consumption are felt and observed through a number of signs and symptoms:

  • Altered speech
  • Difficulty walking
  • Dulled senses
  • Illegible handwriting
  • Impaired hearing
  • Mental confusion
  • Memory lapses
  • Poor coordination
  • Slow reaction times

Drugs That Are Classified As Opiates

Derived from the opium of poppy plants, opiates are a Schedule II substance that is prescribed to physical pain. When used as intended, opiates bind to the body’s opioid receptors, blocking pain signals. Opiates and opioids are two terms that are often used interchangeably. Opioid was a term that once was only used to describe synthetic opioids. However, the term opioid is now used to describe all four categories of opiates, which are the endogenous opioids made by the human body, opium alkaloids like codeine and morphine, semi-synthetic opioids such as oxycodone and heroin and fully synthetic opioids like methadone. 

Opiates Are Also a Depressant 

The human body contains naturally occurring opioid-like neurotransmitters and opioid receptors. While these organic substances send signals that block pain, the body does not make enough of its own opioids to stop severe pain or overdose itself. When someone takes opiate drugs, they easily bind to these receptors because they are similar in chemical structure to the body’s natural opioid neurotransmitters. However, opiate drugs do not act the same way as opioid neurotransmitters, which causes the transmission of abnormal messages throughout the body. Heroin’s impact on the body is dependent on a whole host of factors. These factors include the user’s current state of health, their weight, whether they are male or female. How the person takes opiates, how much opiates he or she takes, how long they have engaged in opiate use, the simultaneous consumption of other drugs or alcohol and their mental health also play a role on how heroin will affect the body. In terms of how opiate drugs interfere with these signals produces a variety of effects: 

  • Confusion
  • Constipation
  • Drowsiness
  • Lack of coordination
  • Poor decision making
  • Sedation
  • Shallow breathing

The Effects of Combining Opiates and Alcohol

Since opiates and alcohol are both considered to be depressants, they can be a deadly drug combination when taken together. When someone takes an opiate and drinks alcohol, the opiate will increase the body’s absorption rate of the alcohol, increasing the likelihood of alcohol poisoning. Additionally, this mixture slows down brain functioning and subsequently, the body’s circulatory and respiratory systems. Signs and symptoms of an opiate-alcohol overdose include drowsiness, dizziness and slowed heart rate and breathing rate. Their heart can even stop beating. The longer someone engages in this type of polydrug use, they increase their chances of a fatal overdose

Why Arizona Drug Users Are Taking Opiate-Alcohol Cocktails

With such a high risk of death from consuming opiates and alcohol, it is surprising that the number of fatalities is so high. Often, people turn to this type of substance use to relax as opiates’ ability to cause the feeling of euphoria lasts longer when this drug is combined with alcohol. Other people choose to take both of these substances at the same time as an escape because the combo either makes them fall asleep for a long period of time or gives them a more intense high than taking opiates alone. 

This Dangerous Trend Is Running Rampant Among Youth

The results of 2012 study by McCabe and other researchers indicate that a significant portion of young people are mixing opiates with other substances, including other opiates. Approximately 1 of 8 teenagers in high school have used opiates with for recreational purposes, and 70 percent of these teens are combining opiates with one or more substances. Although they are using opiates in conjunction with amphetamines, tranquilizers, marijuana and cocaine, 52.1 percent of teenagers from this study are also combining opiates with alcohol. 

More People Are Turning to Heroin 

Due to the alarming rate of prescription opioid abuse, authorities in Arizona and the rest of the country are taking a hardline approach to curbing the distribution of these medications. Therefore, people who are dependent or addicted to opiates are using heroin. Estimates by the National Survey on Drug Use and Health show that almost 700,000 people in America are using heroin. Approximately 170,000 people tried heroin for the first time in 2012. Looking at the rates from the 1960s to the 1970s when heroin reached its height of popularity, current heroin-use rates are on reaching the same level. Heroin users state that street heroin is easier to access that legitimate prescriptions and cheaper to buy than illicit prescription painkillers. 

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.