GGC Medicines

Adult Therapeutics Handbook

Management of Problematic Drug Users in Hospital

Management of Problematic Drug Users in Hospital

Table 1 - Subjective opioid withdrawal scale (SOWS)

  2 points 1 point 0 points
Pupil size Wide Normal Pin point
Palms Wet Moist Dry
Skin Goosed Cold Warm
Nasal Running Sniffing Dry
Agitation Can't sit Agitated Calm
GIT Vomiting Nausea Normal
Pulse >100 80-100 <80
TOTAL A score of >5 is strongly suggestive that the patient is suffering from opiate withdrawal

Table 2 - Initial methadone oral dose

Day Methadone dose
1 20mg initially. Reassess 12 hours later and give further 10mg dose only if withdrawal effects are still evident (maximum total dose on day 1 is 30mg)
2 Same total dose as day 1
3 As above

Table 3 -Example of Oral Diazepam dosing regimen

Days Diazepam dose (oral) 
1-3   20mg three times daily for 3 days     
4-6 15mg three times daily for 3 days  
7-9 10mg three times daily for 3 days
10-12    5mg three times daily for 3 days
13-15 5mg twice daily for 3 days
16-18 5mg once daily for 3 days


Guideline reviewed and content updated October 2020