1. Why is naloxone added to Suboxone to treat opioid use disorders?

Suboxone is a medication commonly used to treat opioid use disorders. It is a combination of two active ingredients: buprenorphine and naloxone. Naloxone, an opioid antagonist, is added to Suboxone for specific reasons related to the treatment of opioid addiction.

The primary reason for adding naloxone to Suboxone is to deter misuse and reduce the potential for diversion. Naloxone is an opioid receptor antagonist that blocks the effects of opioids on the brain. When taken as directed, Suboxone has a lower risk of abuse and overdose compared to other opioids due to the presence of naloxone.

If Suboxone is used as prescribed by being placed under the tongue or dissolved in the mouth, the buprenorphine component is absorbed through the mucous membranes and enters the bloodstream. Buprenorphine, a partial opioid agonist, attaches to the same receptors in the brain as other opioids, such as heroin or prescription painkillers. It provides relief from withdrawal symptoms and reduces cravings without producing a strong euphoric effect.

However, if Suboxone is misused by attempting to inject it intravenously, the naloxone component becomes active. Naloxone has a high affinity for opioid receptors and will bind to them, displacing any other opioids present. This results in the rapid reversal of opioid effects, which can precipitate withdrawal symptoms.

The inclusion of naloxone in Suboxone acts as a deterrent against intravenous abuse of the medication. If someone attempts to inject Suboxone, the naloxone will block the effects of the buprenorphine component, leading to immediate withdrawal symptoms. This discourages individuals from misusing Suboxone and reduces its potential for misuse or diversion in the community.

It is important to note that when Suboxone is used as prescribed, by being taken sublingually, the naloxone component has minimal systemic absorption, and the therapeutic effects of buprenorphine are not affected. The naloxone is primarily active if the medication is misused intravenously.

2. What is the COWS?

The Clinical Opiate Withdrawal Scale (COWS) is a widely used assessment tool to measure and monitor the severity of opioid withdrawal symptoms in individuals with opioid use disorder. It provides a standardized way for healthcare professionals to evaluate the level of withdrawal an individual is experiencing and guide treatment decisions.

Withdrawal from opioids can be a challenging and uncomfortable process, and the COWS helps healthcare providers determine the appropriate course of action, such as initiating medication-assisted treatment or adjusting medication dosages. The scale assesses various physical and psychological symptoms commonly associated with opioid withdrawal.

The COWS evaluates 11 different symptoms, assigning a score to each based on their severity. These symptoms include:

• Resting pulse rate
• Gastrointestinal upset
• Sweating
• Tremor
• Restlessness
• Pupil size
• Bone or joint aches
• Runny nose or tearing
• Yawning
• Gooseflesh skin
• Anxiety or irritability

The scoring system allows healthcare providers to determine the overall severity of withdrawal symptoms and make informed decisions regarding treatment interventions. Scores range from 0 to 5 for most symptoms, with higher scores indicating more severe symptoms. The total score is calculated by adding up the individual scores for each symptom.

The COWS assessment is typically conducted by trained healthcare professionals, such as doctors or nurses, who have experience in managing opioid withdrawal. By using this scale, healthcare providers can objectively evaluate the severity of withdrawal symptoms, track progress over time, and adjust treatment plans accordingly.

It is important to note that the COWS should be used as part of a comprehensive assessment, considering other factors such as the individual’s medical history, substance use patterns, and overall well-being. The scale is a useful tool in guiding treatment decisions, but it should be interpreted in conjunction with clinical judgment and expertise.

In conclusion, the Clinical Opiate Withdrawal Scale (COWS) is a standardized tool used to assess the severity of opioid withdrawal symptoms. By evaluating various physical and psychological symptoms associated with withdrawal, healthcare providers can make informed decisions regarding treatment interventions for individuals with opioid use disorder.