Clinical Opiate Withdrawal Scale
(COWS)
Introduction
The Clinical Opiate Withdrawal Scale (COWS) is an 11-item scale designed to be administered by a clinician. This tool can be used in both inpatient and outpatient settings to reproducibly rate common signs and symptoms of opiate withdrawal and monitor these symptoms over time.
APPENDIX 1
Clinical Opiate Withdrawal Scale
| Item | Score |
|---|---|
| 1. Resting pulse rate | |
| 2. GI upset (nausea, vomiting) | |
| 3. Sweating | |
| 4. Tremor | |
| 5. Restlessness | |
| 6. Yawning | |
| 7. Pupil size | |
| 8. Anxiety or irritability | |
| 9. Bone or joint aches | |
| 10. Gooseflesh skin | |
| 11. Runny nose or tearing | |
| Total Score | ________ |
Score: 5-12 = mild; 13-24 = moderate; 25-36 = moderately severe; more than 36 = severe withdrawal.