Validation of the Clinical Opiate Withdrawal Scale (COWS) against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument

D. Andrew Tompkins, MD

Johns Hopkins University School of Medicine
Department of Psychiatry and Behavioral Sciences
Behavioral Pharmacology Research Unit
Baltimore, MD

Opiate withdrawal syndrome refers to a constellation of symptoms that occurs when opioids are discontinued after significant or prolonged use. Although these symptoms are rarely life-threatening, they can be difficult to tolerate. Dysphoric mood, muscular pains, nausea, general weakness, and insomnia often reach peak intensity 2 to 4 days after discontinuation of a short half-life opioid. Several instruments have been developed to measure opioid withdrawal quantitatively. These include the Clinical Institute Narcotic Assessment (CINA) and the Clinical Opiate Withdrawal Scale (COWS). This industry-supported study assessed the validity of the COWS when compared with the CINA using double-blind, placebo-controlled challenge with the opioid antagonist naloxone in opioid-dependent individuals. In addition, the COWS, CINA, and single-item subjective ratings on a visual analogue scale (VAS) were compared to determine whether one overall item can be used to assess opioid withdrawal. The authors found that the COWS correlates well with the CINA, and that the COWS and VAS items may be useful in both inpatient and outpatient settings, including detoxification and research protocols.

References

Tompkins DA, Bigelow GE, Harrison JA, et al. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009;105:154-159.
Wesson DR, Ling W. The clinical opiate withdrawal scale (COWS). J. Psychoactive Drugs. 2003;35:253-259.
Gowing L, Ali R, White JM. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev. 2009;(3):CD002025.
Peachey JE, Lei H. Assessment of opioid dependence with naloxone. Br J Addict. 1988;83:193-201.

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