Wesson Donald R, Ling Walter
CNS Medications Development, Oakland, California, USA.
J Psychoactive Drugs. 2003 Apr-Jun;35(2):253-9. doi: 10.1080/02791072.2003.10400007.
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.
临床阿片类药物戒断量表（COWS）是一种由临床医生操作的纸笔式工具，用于对11种常见的阿片类药物戒断体征或症状进行评分。这11项的总分可用于评估患者的阿片类药物戒断水平，并推断其对阿片类药物的身体依赖程度。随着阿片类药物在疼痛治疗中的使用增加，以及美国舌下含服丁丙诺啡用于治疗阿片类药物依赖的可用性，阿片类药物戒断强度的临床评估重新受到关注。丁丙诺啡是μ受体的部分阿片类激动剂，可使未经历阿片类药物戒断的高阿片类药物依赖患者出现阿片类药物戒断症状。自20世纪30年代中期首个阿片类药物戒断量表问世以来，临床和研究环境中使用了许多不同的阿片类药物戒断量表。本文回顾了阿片类药物戒断量表的历史及其最初使用的背景。附录中提供了可复制并用于临床的COWS模板版本。美国成瘾医学协会、加利福尼亚成瘾医学协会、加州大学洛杉矶分校综合药物滥用项目以及AlcoholMD.com网站也提供PDF格式的COWS版本。
