Why is naloxone added to Suboxone to treat opioid use disorders? Clinical Opiate Withdrawal Scale
What is the COWS?
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The COWS test measures 11 opiate withdrawal symptoms and rates each based on various criteria.
The resting pulse rate- it is measured while the patient is sitting or lying for at least one minute so that they are in a relaxed or resting state. It is measured 1-4, if 80 or below is it a 0 and for 81-100 is a 1 and goes up to 4 if pulse is over 120.
Sweating -assessing patients’ chills or sweating. If no sweating or chills it is a 0 up to 4 if the patient has noticeable sweat on their face.
Restlessness -depending on what the assessor sees while they are assessing the patient. Sitting still is a 0 while a score of 5 is for someone who can’t sit still for more than a couple of seconds.
Pupil size- while assessing in ambient lighting, if pupils appear normal then it is 0 but if pupils are bold and very dilated then it is given a score of 5.
GI Upset- depending on c/o of GI upset will depend on the score given, if the patient has no GI upset in the past 30 minutes the score is 0. If there has been multiple episodes of diarrhea or vomiting in the past 30 minutes a score of 5 is given.
Bone or Joint Aches-Depending on recent bone or joint pain will depend on score. No new pain is 0 and extreme discomfort in joints and bones is a 4.
Runny nose and tearing- Newly runny nose will be assessed only. If no new runny nose or eye watering is 0 but if has persistent runny nose or tears that stream down the face is a 4 on the COWS scale.
Tremor- having the patient stretch his hands out, it will be assessed the presence of tremors. No shaking is a 0 and major signs of tremor is a 4 in the COWS score.
Anxiety or irritability-If there is no signs of irritability or anxiety then it is a 0, if extreme anxiety is noted or very irritable are shown then it is a 4.
Goosebumps-a score of 0 is given to patients who has smooth skin during assessment, 3 if patient feels hairs standing up on their arms or legs, and a 5 when the gooseflesh is prominent on the arms, legs or other areas of the body.
Yawning-the presence of yawning that takes place several times per minute will score a 4 and if no yawning then the score is a 0.
All these scores are totaled and depending on the score will depend on the severity of the opiate withdrawal and the treatment. A score of 5-12 is considered a mild opiate withdrawal case while 36 or more is severe. Treatments vary based on the outcome of the clinical opiate withdrawal scale assessment and their own individual circumstances.
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