From the Research
A CINA (Clinical Institute Narcotic Assessment) score of 16 indicates moderate to severe opioid withdrawal symptoms, requiring prompt medical intervention with medications such as buprenorphine, methadone, or symptom-targeted medications like clonidine for hypertension, loperamide for diarrhea, and non-opioid pain relievers. This score suggests that the patient is experiencing significant discomfort and physiological disturbances. The CINA scale typically ranges from 0 to 31, with higher scores reflecting more severe withdrawal symptoms. A score of 16 falls in the middle to upper range, signaling that the patient is likely experiencing symptoms such as sweating, restlessness, irritability, dilated pupils, elevated vital signs, gastrointestinal distress, and possibly bone or joint aches.
Key Considerations
- The physiological basis for these symptoms stems from the sudden absence of opioids, causing an unregulated increase in norepinephrine release throughout the body, which drives many of the uncomfortable withdrawal manifestations 1.
- Regular reassessment using the CINA scale can help track the effectiveness of interventions and guide adjustments to the treatment plan.
- Buprenorphine is more effective than clonidine or lofexidine for managing opioid withdrawal in terms of severity of withdrawal, duration of withdrawal treatment, and the likelihood of treatment completion 1.
- Treatment should be tailored to the individual patient's needs, taking into account the severity of withdrawal symptoms, medical history, and other factors.
Treatment Options
- Buprenorphine: effective for managing opioid withdrawal, with a lower average withdrawal score and higher treatment completion rates compared to clonidine or lofexidine 1.
- Methadone: may be equally effective as buprenorphine, but data are limited 1.
- Symptom-targeted medications: such as clonidine for hypertension, loperamide for diarrhea, and non-opioid pain relievers, can help manage specific symptoms.
- Tramadol: may be comparable to buprenorphine in the management of mild to moderately severe heroin withdrawal, but more research is needed 2, 3.