Journal ArticleDOI
The Clinical Opiate Withdrawal Scale (COWS)
Donald R. Wesson,Walter Ling +1 more
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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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A Phase 2b, Randomized, Double-Blind Placebo-Controlled Study to Evaluate the Efficacy and Safety of Naldemedine for the Treatment of Opioid-Induced Constipation in Patients with Chronic Noncancer Pain.
TL;DR: Naldemedine 0.2 mg once daily is the optimal dose for future confirmatory trials in OIC, and incidences of treatment-emergent adverse events were generally mild to moderate in severity; incidences increased with naldemedines dose.
Journal ArticleDOI
Acute pain management in patients with drug dependence syndrome.
Jane Quinlan,Felicia Cox +1 more
TL;DR: Managing patients with dependence requires knowledge of pharmacology; an understanding of the diagnosis of dependence and recognition of withdrawal; skills in communication and collaborative working; and a nonjudgmental, empathic attitude.
Journal ArticleDOI
A double-blind, double-dummy, randomized, prospective pilot study of the partial Mu opiate agonist, buprenorphine, for acute detoxification from heroin
Michael R. Oreskovich,Andrew J. Saxon,Mei Ling K. Ellis,Carol A. Malte,Joseph P. Reoux,Patricia C. Knox +5 more
TL;DR: Both HD and LD regimens are safe and efficacious treatment for opioid detoxification, but HD demonstrated superiority to C on a greater number of measures.
Journal ArticleDOI
Perioperative pain therapy in opioid abuse.
TL;DR: This article intends to simplify the management of drug-dependent patients and offers strategies for perioperative analgesia that include stabilisation of physical dependency by substitution with methadone or &mgr;-agonists; avoidance of stress; use of regional techniques in combination with non-opioids or opioids with higher doses than those used in non-addicts.
Journal ArticleDOI
Common transcriptional effects in the mouse striatum following chronic treatment with heroin and methamphetamine.
Marcin Piechota,Michal Korostynski,Magdalena Sikora,Slawomir Golda,Jaroslaw Dzbek,Ryszard Przewlocki +5 more
TL;DR: It is suggested that transient gene expression alterations during drug treatment and in the early period of withdrawal are involved in the establishment of persistent neuroplastic alterations responsible for the development of drug addiction.
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.