The past, present and future of opioid withdrawal assessment: a scoping review of scales and technologies

Abstract

Background: A common challenge with all opioid use disorder treatment paths is withdrawal management. When withdrawal symptoms are not effectively monitored and managed, they lead to relapse which often leads to deadly overdose. A prerequisite for effective opioid withdrawal management is early identification and assessment of withdrawal symptoms.

Objective: The objective of this research was to describe the type and content of opioid withdrawal monitoring methods, including surveys, scales and technology, to identify gaps in research and practice that could inform the design and development of novel withdrawal management technologies.

Methods: A scoping review of literature was conducted. PubMed, EMBASE and Google Scholar were searched using a combination of search terms.

Results: Withdrawal scales are the main method of assessing and quantifying opioid withdrawal intensity. The search yielded 18 different opioid withdrawal scales used within the last 80 years. While traditional opioid withdrawal scales for patient monitoring are commonly used, most scales rely heavily on patients' self-report and frequent observations, and generally suffer from lack of consensus on the criteria used for evaluation, mode of administration, type of reporting (e.g., scales used), frequency of administration, and assessment window.

Conclusions: It is timely to investigate how opioid withdrawal scales can be complemented or replaced with reliable monitoring technologies. Use of noninvasive wearable sensors to continuously monitor physiologic changes associated with opioid withdrawal represents a potential to extend monitoring outside clinical setting.

Keywords: Opioid use disorder; Physiological monitoring; Questionnaires; Scales; Surveys; Wearable sensor.

Fig. 1

Percent change from baseline year 2000 of opioid deaths (8407 deaths in 2000) vs. heart disease deaths (728,796 deaths in 2000) from 2000 to 2016. For each category, percent change for each year was calculated as [(number of deaths in that year - number of deaths in year 2000)/number of deaths in year 2000] × 100. Data obtained from [6]

Fig. 2

Process of searching and selecting articles included in the scoping review

Fig. 3

Timeline of opioid withdrawal scales development

Fig. 4

a Signs versus number of scales they appeared on; b Symptoms versus number of scales they appeared on