From the Guidelines
For a cow with an opioid withdrawal score of 16, I recommend administering 4-8 mg of buprenorphine (Subutex) sublingually based on the severity of withdrawal, as indicated by the Clinical Policy for critical issues related to opioids in adult patients presenting to the emergency department 1. The dose of 4-8 mg is chosen because the cow's withdrawal score of 16 falls into the moderate to severe category, which requires a higher dose of buprenorphine to effectively manage withdrawal symptoms.
- Key considerations for administering buprenorphine include:
- Re-assessing the patient and COWS score after 30-60 minutes to determine the need for additional doses
- Monitoring the animal closely for signs of overdose or adverse reactions, such as respiratory depression
- Ensuring adequate hydration and nutritional support during treatment to prevent complications
- Gradually tapering the dose as withdrawal symptoms improve to prevent rebound withdrawal The use of buprenorphine for opioid withdrawal in cows is supported by its effectiveness as a partial opioid agonist, which reduces withdrawal symptoms while causing less respiratory depression than full agonists 1.
- Important factors to consider when treating opioid withdrawal in cows include:
- The severity of withdrawal symptoms, as indicated by the COWS score
- The individual animal's response to treatment, which may vary depending on factors such as age, health status, and prior opioid exposure
- The need for ongoing monitoring and adjustment of treatment to ensure effective management of withdrawal symptoms and prevention of complications.
From the Research
Opioid Withdrawal Management
- The Clinical Opiate Withdrawal Scale (COWS) is a clinician-administered, pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms 2.
- The COWS is used to quantify the severity of opiate withdrawal, with higher scores indicating more severe withdrawal 3.
- A score of 16 on the COWS indicates moderate to severe opioid withdrawal.
Buprenorphine for Opioid Withdrawal
- Buprenorphine is a partial opioid agonist that can be used to manage opioid withdrawal 4.
- Buprenorphine has been shown to be effective in reducing the severity of opioid withdrawal and improving treatment outcomes 4.
- The use of buprenorphine to manage withdrawal allows individuals to continue on this highly effective treatment 5.
Subutex (Buprenorphine) Dosage
- There is no specific dosage of Subutex (buprenorphine) recommended for opioid withdrawal with a COWS score of 16 3, 2, 6, 4, 5.
- The dosage of buprenorphine for opioid withdrawal is typically individualized and based on the patient's response to treatment 4.
- Rapid increases in buprenorphine dose can be used as an effective treatment for buprenorphine-induced precipitated opioid withdrawal 5.