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Sex differences may exist in opioid use disorder (OUD) treatment. This study examined the treatment effects of buprenorphine/naloxone (BUP/NX) and methadone (MET) on the Clinical Opiate Withdrawal Scale (COWS) score in individuals with OUD and tested whether the associations differ by sex. We performed a secondary analysis of the data from the National Drug Abuse Treatment Clinical Trials Network (CTN) protocol-0027. A total of 1269 participants (861 males and 408 females) being aged 18 or older with OUD were randomly assigned to receive BUP/NX (n = 740) or MET (n = 529). The paired t test was initially used to compare the COWS scores between pre-dose and post-dose for BUP/NX and MET treatments, separately. The linear mixed model was used to examine the changes in COWS score adjusted for baseline demographic, substance use, and mental health disorders. The interaction of sex and treatment was detected and stratified analysis by sex was conducted. The paired t test showed that both BUP/NX and MET treatments significantly reduced the COWS scores (p values <0.0001). BUP/NX revealed higher COWS scores than MET (p = 0.0008) and females demonstrated significantly higher COWS scores than males (p = 0.0169). Stratified by sex, BUP/NX compared with MET revealed higher COWS scores only in males (p = 0.0043), whereas baseline amphetamines use disorder and major depressive disorder were significantly associated with COWS scores in females (p = 0.0158 and 0.0422, respectively). Both BUP/NX and MET are effective in decreasing opioid withdrawal symptoms via COWS scores, however, treatment plans for OUD by clinical providers should consider sex differences. [ABSTRACT FROM AUTHOR]

Introduction: In 2017, more than 1,200 opioid-related deaths were reported in Virginia, with slightly fewer in 2018, at 1,193 deaths. The current opioid crisis has placed a strain on an already limited number of mental health (MH) inpatient beds. The industry standard for assessment and treatment of opioid withdrawal symptoms, in the inpatient setting, is the Clinical Opiate Withdrawal Scale (COWS), and yet some units continue to utilize the Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) for this population. Aim: The purpose of this nurse-led performance improvement project was to implement COWS in the inpatient MH setting and improve length of stay (LOS) by 1 day. Method: In 2018, in a large federal teaching facility in the mid-Atlantic region, the COWS was implemented to replace the CIWA-Ar for opioid withdrawal, with the focus on decreasing LOS. Prior to implementation of COWS, LOS on the inpatient MH unit for opioid withdrawal was 8.6 days, which was higher than the ~6- to 7-day LOS for surrounding private sector hospitals. Individual electronic medical records were reviewed for LOS and completion of COWS and pertinent details were discussed daily with nursing staff and monthly with the interdisciplinary team. Baseline data were collected from April 2017 to March 2018, with data collection continuing through the project implementation, April to September 2018. Results: Completion of COWS on 100% of patients admitted with opioid withdrawal and a decrease in LOS from 8.6 to 4.7 days was found, a 45% reduction. Conclusion: The nurse-driven performance improvement project affected business acumen, through decreased LOS, as well as quality of care, through better symptom management. [ABSTRACT FROM AUTHOR]

Abstract Aim We assessed the efficacy of buprenorphine replacement taper therapy in a psychiatric hospital in Japan. Methods Based on the medical records, a retrospective analysis was performed to evaluate the outcomes of buprenorphine replacement taper therapy in 106 subjects with heroin dependence. Results We found that replacement and taper therapy with buprenorphine could significantly reduce withdrawal symptoms during detoxification. In addition, the completion rate of detoxification was significantly improved and the length of hospital stay was significantly reduced relative to those who received conventional treatment without buprenorphine. However, the readmission rate increased after the introduction of detoxication therapy with buprenorphine. Conclusion The present findings suggest not only the efficacy and safety of buprenorphine replacement and taper therapy, but also the requirement for maintenance therapy for individuals with heroin dependence.

BackgroundThe Clinical Opiate Withdrawal Scale (COWS) is used to assess withdrawal in clinical trials and practice. The aims of this study were to examine the inter-item correlations and factor structure of the COWS in opioid-dependent men and women.MethodsThis is a secondary data analysis of the National Drug Abuse Treatment Clinical Trials Network 0003, a randomized clinical trial that compared buprenorphine/naloxone tapering strategies. The trial included 11 sites in 10 US cities. Participants were opioid-dependent individuals (n=516) that had data on the COWS. The COWS at study baseline was analyzed in this study.ResultsInter-item correlations showed weak to moderate relationships among the items. A 1-factor model did not fit the data for men (comparative fit index (CFI)=.801, root mean square error of approximation (RMSEA)=.073, weighted root mean square residual (WRMR)=1.132) or women (CFI=.694, RMSEA=.071, WRMR=.933), where resting pulse rate was not related to withdrawal for men, and yawning and gooseflesh skin was not related to withdrawal for women. A reduced model comprised of only the 8 items that were significantly related to the construct of withdrawal in both men and women, and an exploratory 2-factor model, were also assessed but not retained due to inconsistencies across gender.ConclusionsWhen traditional psychometric models are applied to the COWS, it appears that the scale may not relate to a single underlying construct of withdrawal. Further research testing the hypothesized factor structure in other opioid-dependent samples is needed.

Aim: We assessed the efficacy of buprenorphine replacement taper therapy in a psychiatric hospital in Japan. Methods: Based on the medical records, a retrospective analysis was performed to evaluate the outcomes of buprenorphine replacement taper therapy in 106 subjects with heroin dependence. Results: We found that replacement and taper therapy with buprenorphine could significantly reduce withdrawal symptoms during detoxification. In addition, the completion rate of detoxification was significantly improved and the length of hospital stay was significantly reduced relative to those who received conventional treatment without buprenorphine. However, the readmission rate increased after the introduction of detoxication therapy with buprenorphine. Conclusion: The present findings suggest not only the efficacy and safety of buprenorphine replacement and taper therapy, but also the requirement for maintenance therapy for individuals with heroin dependence. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the present study was to perform reliability and validity analyses of the Turkish version of the Clinical Opiate Withdrawal Scale which is used to determine the severity of opiate withdrawal. Methods: Initially, the Clinical Opiate Withdrawal Scale (COWS) was translated into Turkish and subsequently back-translated into English. The originality of the back-translated version was approved by the author who developed the scale. After the translation was completed, the scale was used to assess the withdrawal symptoms of 100 patients with opiate withdrawal and 41 patients with alcohol withdrawal. Cronbach's alpha was used in the reliability assessment; explanatory and confirmatory factor analyses were used in structural validity assessment; and in scale validity, ROC analysis was used among diagnosis groups. Results: The Cronbach's alpha internal consistency coefficient was calculated as 0.74 in reliability analyses. The correlation coefficient was found to be 0.975 (p<0.001) for inter-rater reliability. Factor analysis was conducted for the structural validity of the scale and findings that support the unidimensional structure of the scale were observed. In the confirmatory factor analysis, CFI, GFI and RMSEA values were found to be 0.905, 0.905 and 0.079, respectively. It was detected that COWS was successful in distinguishing between opiate and alcohol withdrawal symptoms and the area under the ROC curve was 0.878. Conclusion: This study showed that the Turkish version of COWS can be used reliably and validly for assessing opiate withdrawal. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The Clinical Opiate Withdrawal Scale (COWS) is an 11-item clinician-administered scale assessing opioid withdrawal. Though commonly used in clinical practice, it has not been systematically validated. The present study validated the COWS in comparison to the validated Clinical Institute Narcotic Assessment (CINA) scale. Method: Opioid-dependent volunteers were enrolled in a residential trial and stabilized on morphine 30mg given subcutaneously four times daily. Subjects then underwent double-blind, randomized challenges of intramuscularly administered placebo and naloxone (0.4mg) on separate days, during which the COWS, CINA, and visual analog scale (VAS) assessments were concurrently obtained. Subjects completing both challenges were included (N =46). Correlations between mean peak COWS and CINA scores as well as self-report VAS questions were calculated. Results: Mean peak COWS and CINA scores of 7.6 and 24.4, respectively, occurred on average 30min post-injection of naloxone. Mean COWS and CINA scores 30min after placebo injection were 1.3 and 18.9, respectively. The Pearson''s correlation coefficient for peak COWS and CINA scores during the naloxone challenge session was 0.85 (p <0.001). Peak COWS scores also correlated well with peak VAS self-report scores of bad drug effect (r =0.57, p <0.001) and feeling sick (r =0.57, p <0.001), providing additional evidence of concurrent validity. Placebo was not associated with any significant elevation of COWS, CINA, or VAS scores, indicating discriminant validity. Cronbach''s alpha for the COWS was 0.78, indicating good internal consistency (reliability). Discussion: COWS, CINA, and certain VAS items are all valid measurement tools for acute opiate withdrawal. [Copyright &y& Elsevier]

Background: Opioid-related inpatient hospital stays are increasing at alarming rates. Unidentified and poorly treated opioid withdrawal may be associated with inpatients leaving against medical advice and increased health care utilization. To address these concerns, we developed and implemented a clinical pathway to screen and treat medical service inpatients for opioid withdrawal., Methods: The pathway process included a two-item universal screening instrument to identify opioid withdrawal risk (Opioid Withdrawal Risk Assessment [OWRA]), use of the validated Clinical Opiate Withdrawal Scale (COWS) to monitor opioid withdrawal symptoms and severity, and a 72-h buprenorphine/naloxone-based treatment protocol. Implementation outcomes including adoption, fidelity, and sustainability of this new pathway model were measured. To assess if there were changes in nursing staff acceptability, appropriateness, and adoption of the new pathway process, a cross-sectional survey was administered to pilot four hospital medical units before and after pathway implementation., Results: Between 2016 and 2018, 72.4% (77,483/107,071) of admitted patients received the OWRA screening tool. Of those, 3.0% (2,347/77,483) were identified at risk for opioid withdrawal. Of those 2,347 patients, 2,178 (92.8%) were assessed with the COWS and 29.6% (645/2,178) were found to be in active withdrawal. A total of 49.5% (319/645) patients were treated with buprenorphine/naloxone. Fifty-seven percent (83/145) of nurses completed both the pre- and post-pathway implementation surveys. Analysis of the pre/post survey data revealed that nurse respondents were more confident in their ability to determine which patients were at risk for withdrawal ( p = .01) and identify patients currently experiencing withdrawal ( p < .01). However, they cited difficulty working with the patient population and coordinating care with physicians., Conclusions: Our study demonstrates a process for successfully implementing and sustaining a clinical pathway to screen and treat medical service inpatients for opioid withdrawal. Standardizing care delivery for patients in opioid withdrawal can also improve nursing confidence when working with this complex population.

Purpose/goals: The purpose of this presentation is to provide critical care nurses with a basic level of knowledge for recognizing and managing the signs and symptoms of acute opioid withdrawal in an adult inpatient population. Additionally, this presentation will provide nurses with an improved understanding of substance use disorder, concurrent disorders, harm reduction opportunities, and advocacy points for individuals negatively impacted by systemic or socioeconomic disadvantages. Outcome 1: To become familiarized with the Clinical Opiate Withdrawal Scale (COWS) and its application for critical care inpatients. Outcome 2: To develop a deeper understanding of social factors that contribute to poor coping mechanisms, including substance use disorders. Outcome 3: To gain a base level of knowledge on harm reduction opportunities including take home naloxone, safer injecting practices, and overdose prevention. Session description: The fallout of the current Canadian opiate crisis extends beyond city streets and places a tremendous strain on emergency departments, ICUs, and inpatient hospital units. Individuals using opiates may be admitted into these areas with overdose, or for any of several other reasons while maintaining an underlying opiate use disorder. It is vital for critical care nurses to be aware of the signs of opiate withdrawal, as patients may be unable to express their substance use histories or discomfort due to neurological incapacitation or intubation. The symptoms of opiate withdrawal dramatically impact individuals' experiences and add to trauma and delirium experienced in hospital stays. Critical care nurses would benefit from a greater understanding of opioid use disorder (OUD), clinical manifestations of, and management for opiate withdrawal, and patient advocacy opportunities for this community. The presentation will use case studies and engage participants in open discussion to examine the standardized assessment tool for recognizing opiate withdrawal, opiate agonist therapy and other pharmaceutical intervention options, as well as discussion of the impact of trauma and concurrent mental health disorders that influence individuals' use of illicit substances. The presentation will also provide education on harm reduction opportunities including safer injection teaching, overdose prevention strategies, and take-home naloxone kits. [ABSTRACT FROM AUTHOR]

Background: The Clinical Opiate Withdrawal Scale (COWS) is used to assess withdrawal in clinical trials and practice. The aims of this study were to examine the inter-item correlations and factor structure of the COWS in opioid-dependent men and women., Methods: This is a secondary data analysis of the National Drug Abuse Treatment Clinical Trials Network 0003, a randomized clinical trial that compared buprenorphine/naloxone tapering strategies. The trial included 11 sites in 10 US cities. Participants were opioid-dependent individuals (n=516) that had data on the COWS. The COWS at study baseline was analyzed in this study., Results: Inter-item correlations showed weak to moderate relationships among the items. A 1-factor model did not fit the data for men (comparative fit index (CFI)=.801, root mean square error of approximation (RMSEA)=.073, weighted root mean square residual (WRMR)=1.132) or women (CFI=.694, RMSEA=.071, WRMR=.933), where resting pulse rate was not related to withdrawal for men, and yawning and gooseflesh skin was not related to withdrawal for women. A reduced model comprised of only the 8 items that were significantly related to the construct of withdrawal in both men and women, and an exploratory 2-factor model, were also assessed but not retained due to inconsistencies across gender., Conclusions: When traditional psychometric models are applied to the COWS, it appears that the scale may not relate to a single underlying construct of withdrawal. Further research testing the hypothesized factor structure in other opioid-dependent samples is needed., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)