Journal ArticleDOI
The Clinical Opiate Withdrawal Scale (COWS)
Donald R. Wesson,Walter Ling +1 more
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TLDR
The history of opiate withdrawal scales is reviewed and a template version of the COWS that can be copied and used clinically is appended.Abstract:
The clinical opiate withdrawal scale (COWS) is a clinician-administered, pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms. The summed score of the eleven items can be used to assess a patient's level of opiate withdrawal and to make inferences about their level of physical dependence on opioids. With increasing use of opioids for treatment of pain and the availability of sublingual buprenorphine in the United States for treatment of opioid dependence, clinical assessment of opiate withdrawal intensity has received renewed interest. Buprenorphine, a partial opiate agonist at the mu receptor, can precipitate opiate withdrawal in patients with a high level of opioid dependence who are not experiencing opioid withdrawal. Since development of the first opiate withdrawal scale in the mid-1930s, many different opioid withdrawal scales have been used in clinical and research settings. This article reviews the history of opiate withdrawal scales and the context of their initial use. A template version of the COWS that can be copied and used clinically is appended. PDF formatted versions of the COWS are also available from the websites of the American Society of Addiction Medicine, the California Society of Addiction Medicine, the UCLA Integrated Substance Abuse Programs, and AlcoholMD.com.read more
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Journal ArticleDOI
Identification, Management, and Transition of Care for Patients With Opioid Use Disorder in the Emergency Department.
Herbert C. Duber,Isabel A. Barata,Eric Cioè-Peña,Stephen Y. Liang,Eric M Ketcham,Wendy Macias-Konstantopoulos,Shawn A. Ryan,Mark Stavros,Lauren K. Whiteside +8 more
TL;DR: This clinical review article examines current strategies for identifying patients with opioid use disorder, the treatment of patients with acute opioid withdrawal syndrome, approaches to medication‐assisted therapy, and the transition of patients from the emergency department to outpatient services.
Journal ArticleDOI
Impact of cannabis use during stabilization on methadone maintenance treatment.
TL;DR: Objective rates of cannabis use were high during methadone induction, dropping significantly following dose stabilization, and pilot data suggested that objective ratings of opiate withdrawal decrease in MMT patients using cannabis during stabilization.
Journal ArticleDOI
Rapid micro-induction of buprenorphine/naloxone for opioid use disorder in an inpatient setting: A case series.
TL;DR: Two patients with opioid use disorder were successfully started on buprenorphine/naloxone using a rapid micro-induction technique that did not cause precipitated withdrawal or require preceding cessation of other opioids.
Journal ArticleDOI
Cebranopadol, a novel first-in-class analgesic drug candidate: first experience in patients with chronic low back pain in a randomized clinical trial.
TL;DR: Evaluating the analgesic efficacy, safety, and tolerability of cebranopadol in patients with moderate-to-severe chronic LBP with and without neuropathic pain component found that higher doses leading to higher treatment discontinuations had an acceptable tolerability profile.
Journal ArticleDOI
Long-Acting Injectable Naltrexone Induction: A Randomized Trial of Outpatient Opioid Detoxification With Naltrexone Versus Buprenorphine.
Maria A. Sullivan,Adam Bisaga,Martina Pavlicova,C. Jean Choi,Kaitlyn Mishlen,Kenneth M. Carpenter,Frances R. Levin,Elias Dakwar,John J. Mariani,Edward V. Nunes +9 more
TL;DR: These results demonstrate the safety, efficacy, and tolerability of low-dose naltrexone, in conjunction with single-day buprenorphine dosing and adjunctive nonopioid medications, for initiating adults with opioid dependence to XR-naltrex one.
References
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Journal ArticleDOI
Assessment of Alcohol Withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar)
TL;DR: A shortened 10-item scale for clinical quantitation of the severity of the alcohol withdrawal syndrome has been developed and can be incorporated into the usual clinical care of patients undergoing alcohol withdrawal and into clinical drug trials of alcohol withdrawal.
Journal ArticleDOI
Two New Rating Scales for Opiate Withdrawal
Leonard Handelsman,Kenneth J. Cochrane,Marvin J. Aronson,Robert Ness,Karen J. Rubinstein,Philip D. Kanof +5 more
TL;DR: In this paper, two rating scales for measuring the signs and symptoms of opiate withdrawal are presented: Subjective Opiate Withdrawal Scale (SOWS) contains 16 symptoms whose intensity the patient rates on a scale of 0 (not at all) to 4 (extremely).
Two new rating scales for opiate withdrawal
Leonard Handelsman,Kenneth J. Cochrane,Marvin J. Aronson,Robert Ness,Karen J. Rubinstein,Philip D. Kanof +5 more
TL;DR: Good interrater reliability for the OOWS and good intrasubject reliability over time for both scales are demonstrated to be valid and reliable indicators of the severity of the opiate withdrawal syndrome over a wide range of common signs and symptoms.
Journal ArticleDOI
The development of a Short Opiate Withdrawal Scale (SOWS)
TL;DR: The processes whereby a shorter 10-item version of the Opiate Withdrawal Scale was developed are described, suggesting that the SOWS provide a useful instrument which can be used both in research and clinical practice with opiate addicts.