Description

A patient who is opioid dependent will develop withdrawal symptoms following administration of naloxone. Judson et al graded the severity of the reaction in order to find those patients who will need to undergo detoxification. The authors are from the Addiction Research Foundation in Palo Alto, California.


Patient selection: positive urine test for opiates or other indication of possible opiate use

 

Protocol:

(1) Inject 0.02 mg naloxone subcutaneously to determine if the patient is allergic.

(2) If not allergic, then inject 0.18 mg IM and observe for 20 minutes.

(3) If no or minimal reaction, then inject 0.18 mg IV.

 

Parameters:

(1) sneezes or coughs

(2) yawns

(3) lacrimation

(4) rhinorrhea

(5) shivering

(6) restlessness

(7) sweating

(8) vomiting

(9) gooseflesh over upper arms and thorax

(10) mydriasis

 

Parameter

Finding

Points

sneezes or coughs

none

1

 

1 or 2

2

 

3 to 10

3

 

>= 11 or uncontrollable

4

yawns

none

1

 

1 or 2

2

 

3 to 10

3

 

>= 11 or uncontrollable

4

lacrimation

none

1

 

barely noticeable watering of the eyes, some blinking

2

 

tearing, blinking, rubbing eyes

3

 

profuse weeping, tears running down face

4

rhinorrhea

none

1

 

barely noticeable sniffing

2

 

visible nasal secretion, postnasal drip

3

 

profuse secretion running from nose

4

shivering

none

1

 

barely noticeable

2

 

bouts

3

 

continuous and uncontrollable, teeth chattering

4

restlessness

none

1

 

more than normal

2

 

repeated movements of limbs, shifting of body position

3

 

continual movement, unable to sit still

4

sweating

none

1

 

barely noticeable, moist palms

2

 

visible wetness of skin

3

 

dripping

4

vomiting

none

1

 

retching

2

 

1 or 2 episodes of vomiting

3

 

uncontrollable vomiting or >= 3 episodes

4

gooseflesh

none

1

 

transient or intermittent

2

 

lasts 30-60 seconds

3

 

persistent, over most of body, palpable

4

mydriasis

none

1

 

increased 1-2 mm

2

 

increased 3-4 mm

3

 

increased >= 5 mm

4

 

total score =

= SUM(points for all 10 parameters)

 

Interpretation:

• minimum score: 10

• maximum score: 40

• The higher the score the greater the severity of withdrawal symptoms.


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