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COWS (opioid withdrawal)
Clinical Opiate Withdrawal Scale.
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Last reviewed 2026-01-06
|
substance-use | withdrawal | opioids
Inputs
COWS: Resting pulse rate
Select
80 or less (0)
81 to 100 (1)
101 to 120 (2)
Greater than 120 (4)
COWS: Sweating
Select
None (0)
Subjective chills or flushing (1)
Observed sweating (2)
Beads of sweat (3)
Drenching sweat (4)
COWS: Restlessness
Select
Able to sit still (0)
Reports difficulty sitting still (1)
Frequent shifting (3)
Unable to sit still (5)
COWS: Pupil size
Select
Normal (0)
Possibly larger than normal (1)
Moderately dilated (2)
So dilated only rim of iris visible (5)
COWS: Bone or joint aches
Select
None (0)
Mild diffuse discomfort (1)
Moderate discomfort (2)
Severe discomfort (4)
COWS: Runny nose or tearing
Select
Not present (0)
Nasal stuffiness or moist eyes (1)
Runny nose or tearing (2)
Profuse tearing or runny nose (4)
COWS: GI upset
Select
None (0)
Stomach cramps (1)
Nausea or loose stool (2)
Vomiting or diarrhea (3)
Multiple episodes (5)
COWS: Tremor
Select
No tremor (0)
Tremor can be felt but not seen (1)
Tremor observable (2)
Gross tremor (4)
COWS: Yawning
Select
No yawning (0)
Yawning 1 to 2 times/30 min (1)
Yawning 3 to 4 times/30 min (2)
Yawning 5 or more times/30 min (4)
COWS: Anxiety or irritability
Select
None (0)
Mild (1)
Moderate (2)
Severe (4)
COWS: Gooseflesh skin
Select
Skin is smooth (0)
Piloerection (3)
Prominent piloerection (5)
Enter values to see the result.
References
Clinical Opiate Withdrawal Scale (Wesson and Ling, 2003)