Two New Rating Scales for Opiate Withdrawal

TLDR

The study introduces two new scales to assess opiate withdrawal symptoms. The authors developed the Subjective Opiate Withdrawal Scale (SOWS) with 16 self‑rated items and the Objective Opiate Withdrawal Scale (OOWS) with 13 observable signs, and tested them by challenging patients with placebo or naloxone. The scales showed higher scores before methadone, increased scores after naloxone challenge, and demonstrated strong inter‑ and intra‑rater reliability, confirming their validity for measuring withdrawal severity.

Abstract

Two new rating scales for measuring the signs and symptoms of opiate withdrawal are presented. The Subjective Opiate Withdrawal Scale (SOWS) contains 16 symptoms whose intensity the patient rates on a scale of 0 (not at all) to 4 (extremely). The Objective Opiate Withdrawal Scale (OOWS) contains 13 physically observable signs, rated present or absent, based on a timed period of observation of the patient by a rater. Opiate abusers admitted to a detoxification ward had significantly higher scores on the SOWS and OOWS before receiving methadone as compared to after receiving methadone for 2 days. Opiate abusers seeking treatment were challenged either with placebo or with 0.4 mg naloxone. Postchallenge SOWS and OOWS scores were significantly higher than prechallenge scores in the naloxone but not the placebo group. We have demonstrated good interrater reliability for the OOWS and good intrasubject reliability over time for both scales in controls and in patients on a methadone maintenance program. These 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.