Kolb and Himmelsbach described a score for monitoring a patient undergoing opiate withdrawal. This can help to gauge the severity of the signs and symptoms of abstinence. The authors are from the U.S. Public Health Service.
Patient selection: opiate abstinence
Parameters:
(1) yawning
(2) lacrimation
(3) rhinorrhea
(4) perspiration
(5) anorexia
(6) dilated pupils
(7) tremor
(8) goose-flesh
(9) restlessness
(10) emesis
(11) temperature change in °C (fever)
(12) change in respiratory rate in breaths per minute (hyperpnea)
(13) change in systolic blood pressure in mm Hg
(14) weight loss (in kilograms)
temperature change =
= (current temperature) - (temperature before abstinence)
change in blood pressure =
= (current systolic blood pressure) - (systolic blood pressure before abstinence)
change in blood pressure =
= (current systolic blood pressure) - (systolic blood pressure before abstinence)
weight loss in kilograms =
= (weight before abstinence) - (current weight in kilograms)
|
Parameter
|
Finding
|
Points
|
|
yawning
|
no
|
0
|
|
|
yes
|
1
|
|
lacrimation
|
no
|
0
|
|
|
yes
|
1
|
|
rhinorrhea
|
no
|
0
|
|
|
yes
|
1
|
|
perspiration
|
no
|
0
|
|
|
yes
|
1
|
|
anorexia
|
no
|
0
|
|
|
yes
|
3
|
|
dilated pupils
|
no
|
0
|
|
|
yes
|
3
|
|
tremor
|
no
|
0
|
|
|
yes
|
3
|
|
goose-flesh
|
no
|
0
|
|
|
yes
|
3
|
|
restlessness
|
no
|
0
|
|
|
yes
|
5
|
|
Parameter
|
Points
|
|
emesis
|
5 * (number of episodes)
|
|
temperature
|
MAX(0,10*(temperature change)
|
|
respiratory rate
|
MAX(0, (change in respiratory rate))
|
|
systolic blood pressure
|
MAX(0, MIN(30, ((BP change) / 2)))
|
|
weight loss
|
MAX(0, 2.2 * (weight loss))
|
total score =
= SUM(points for all 14 parameters)
Interpretation:
• minimum score: 0
• maximum score: depends on severity of the clinical signs
