From the Guidelines
The Clinical Institute Narcotic Assessment (CINA) score is a validated tool used to measure withdrawal in adults, particularly for assessing the severity of opioid withdrawal symptoms. The CINA score is utilized to objectively quantify the severity of withdrawal, guiding appropriate treatment decisions and tracking a patient's progress during detoxification 1. This assessment tool evaluates several key parameters, including vital signs and observable symptoms such as sweating, restlessness, tremor, yawning, pupil size, and gastrointestinal distress.
Key Parameters Assessed by CINA Score
- Vital signs: blood pressure, heart rate, respiratory rate, temperature
- Observable symptoms: sweating, restlessness, tremor, yawning, pupil size, gastrointestinal distress Each parameter is assigned a numerical value, with the total score indicating withdrawal severity: higher scores reflect more severe withdrawal symptoms.
Clinical Application of CINA Score
Healthcare providers typically use CINA scores to determine when to administer withdrawal medications and to adjust dosing based on symptom severity, as part of a comprehensive management strategy for opioid withdrawal, which includes prevention through gradual weaning of opioids 1. The CINA score is particularly valuable in inpatient detoxification settings where frequent monitoring is possible, allowing for timely interventions to mitigate withdrawal symptoms and improve patient outcomes.
From the Research
CINA Score for Substance Withdrawal
The Clinical Institute Narcotic Assessment (CINA) score is used to assess the severity of opioid withdrawal symptoms.
- The CINA score is a validated scale used in clinical practice to evaluate the level of opioid withdrawal in patients.
- According to the study 2, the CINA score is correlated with the Clinical Opiate Withdrawal Scale (COWS) and visual analog scale (VAS) assessments, providing evidence of concurrent validity.
- The study 2 found that the mean peak CINA score was 24.4, which occurred on average 30 minutes post-injection of naloxone.
- The CINA score is used in conjunction with other assessment tools, such as the COWS and VAS, to evaluate the severity of opioid withdrawal symptoms and to guide treatment decisions.
Assessment of Opioid Withdrawal
The assessment of opioid withdrawal symptoms is crucial in the management of opioid use disorder.
- The COWS is a widely used clinician-administered scale that assesses 11 common opiate withdrawal signs or symptoms, as described in the study 3.
- The study 4 introduced two new rating scales for measuring the signs and symptoms of opiate withdrawal, the Subjective Opiate Withdrawal Scale (SOWS) and the Objective Opiate Withdrawal Scale (OOWS).
- The study 5 compared the effectiveness of different doses of sublingual buprenorphine and clonidine in opioid detoxification, using the COWS and SOWS to assess withdrawal symptoms.
- The study 6 found that the incidence of buprenorphine-precipitated withdrawal in adults with opioid use disorder is low, and that the initial COWS score can be used to predict the risk of precipitated withdrawal.