Creating and Piloting a Spanish-Language Version of the Clinical Opiate Withdrawal Scale (COWS): La Escala Clínica de Síndrome Abstinencia de Opiáceos (ECAO)

Jessica L Bourdon,1 Seth Jones,2,3 Melanie Arianna Hernandez,4 America Y Lerma,4 Samantha Nava,2,3 Karina Vazquez3 1Department of Psychology, Longwood University, Farmville, VA, USA; 2Department of Psychology, University of Richmond, Richmond, VA, USA; 3Latin American, Latino, and Iberian Studies, University of Richmond, Richmond, VA, USA; 4Department of Biology, University of Richmond, Richmond, VA, USACorrespondence: Jessica L Bourdon, Email [email protected]: Using English-only assessment tools with Spanish-speaking patients can lead to miscommunication and inadequate care. The current study translates the commonly used Clinical Opiate Withdrawal Scale (COWS) into La Escala Clínica de Síndrome Abstinencia de Opiáceos (ECAO) for use by healthcare workers to use with Spanish-speaking patients.Methods: First, the COWS was translated using standard forward/backward methods. Next attitudes and feedback about the ECAO were assessed via a mixed-methods pilot study.Results: The translation went according to plan. The final sample size of the pilot study was N=107 healthcare providers (Mage = 40.00 years; woman = 58.88%; master’s degree = 42.06%). The translation was rated as accurate (M=7.83; SD = 1.71; range 4– 10) with a majority (62.62%) of participants rating it at an 8 or above. Ratings of acceptability, appropriateness, feasibility, understandability, and actionability were also quite high, with agreement across questions in these sections ranging from 72.09– 95.33%. Qualitative results highlighted favorability toward the ECAO such as its accurate and culturally sensitive translation with areas of improvement including use of overly medical terms.Conclusion: Based on the results of this pilot study, the ECAO appears to be an accurate, feasible, useful tool for Spanish-speaking healthcare workers who treat patients struggling with opioid withdrawal. The free availability of the Spanish-language ECAO will help patients and providers communicate adequately in order to determine the extent of opioid withdrawal accuracy as well as develop appropriate treatment plans.Plain Language Summary: There are few widely available Spanish-language tools for measuring opioid withdrawal across medical or clinical settings. This study translated a popular tool, the Clinical Opiate Withdrawal Scale (COWS), into a Spanish-language version, La Escala Clínica de Síndrome Abstinencia de Opiáceos (ECAO). The ECAO was tested among healthcare workers who were generally favorable toward the tool. We encourage widespread dissemination of the ECAO into healthcare facilities to reduce health disparities for Spanish-speaking patients.Keywords: opioid use, withdrawal, assessment, treatment, COWS