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Objective: Measuring the presence and the severity of opioid withdrawal is important for both making the dependency diagnosis, deciding the dose of the medicine that is going to be use and to follow detoxification process. Since buprenorphine /naloxone combination was introduced for treatment, it is even more important to evaluate severity of withdrawal with a scale, because patient has to show withdrawal symptoms to start the medicine. Bakırkoy Opioid Withdrawal Scale (BOWS) is a clinician rated scale that has been used since 1995 in Bakırkoy AMATEM. BOWS includes 13 symptoms of opioid withdrawal and simply rated as present or absent. Thus the total score of the scale is 13 which shows the most severe withdrawal. The psychometric properties of the BOWS, developed to screen severity of opioid withdrawal symptoms among Turkish patients with heroin dependency.
Method: The data were gathered from the Bakırkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery Istanbul. Total of 392 heroin dependent patients (105 inpatient and 287 outpatients) entered to buprenorphine /naloxone maintenance treatment were randomized taken from the Alcohol and Drug Research Training and Treatment Center (AMATEM).
Results: To explore the factorial structure of the BOWS, a principal component analysis (PCA) was performed using all participants (N=392). Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization. Criteria for retaining extracted components on the PCA were: (a) visual inspection of the scree plot to note breaks in size of Eigenvalues between the components, (b) Eigenvalues greater than one, and (c) percentage of variance accounted for by components retained. A visual inspection of the scree plot revealed two components accounting for the majority of variance before components started to level off. Two components on the BOWS reached the criterion of an Eigenvalue greater than one (3.98 and 1.40) and the variance accounted for by these components were 30.61% and 10.76% respectively. Analyses for the factor structure of the BOWS suggests that it has a 2-factor structure accounting for 41.37% of the variance; the first factor consisted of general withdrawal symptoms (Dysphoric mood, Muscle aches, Lacrimation, Rhinorrhea, Dilated pupils, Piloerection, Sweating, Excessive yawning, Fever) and the second factor consisted of gastro intestinal symptoms (Nausea, Vomiting, Stomachache, Diarrhea). All item-component loadings were in the “good” to “excellent” range. Thus, results from the PCA suggest that the BOWS assesses a two dimensional construct. Internal consistency reliability for the BOWS, examined by Cronbach’s alpha, was also very high (coefficient ?=0.805).
Conclusion: The BOWS was developed to classified individuals on a continuum from low to high withdrawal severity among individuals in clinical settings who are likely to meet criteria for a opioid use disorder. Overall, the BOWS was found to have satisfactory psychometric characteristics as an opioid withdrawal scale. The BOWS had high internal consistency reliability (0.81). In conclusion, the present support the use of the BOWS in clinical settings and encourage continued research into its use in Turkey.