Precipitated opioid withdrawal refers to the onset of withdrawal symptoms after administration of an opioid antagonist. This differs from withdrawal caused by cessation of opioid intake.
Measures: either Subjective Opiate Withdrawal Scale (SOWS) or Clinical Opiate Withdrawal Scale (COWS)
Minimal clinically important difference (MCID):
(1) >= 10 point increase in SOWS (15% of range from 0 to 64)
(2) >= 6 point increase in COWS (12% of range from 0 to 48)
Criteria for precipitated opioid withdrawal:
(1) The patient has been receiving an opioid for some time.
(2) The patient has been given naloxone.
(3) There is a minimal clinically important difference in SOWS or COWS within 60 minutes.
Clinical features may include:
(1) lacrimation
(2) yawning
(3) rhinorrhea
(4) diaphoresis
(5) hot flashes
(6) changes in pupillary diameter
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