Clinical Opiate Withdrawal Scale
A rating scale clinicians use to measure how severe opioid withdrawal is and to monitor it over time.
- Category
- Alcohol & drugs
- Items
- 11
- Recall period
- Current state (at the time of assessment)
On this page
Administer the scale
0 of 11 completed
0%Record the patient's response to every item. Entries stay in your browser and are never sent anywhere.
For each item, choose the score that best describes the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient was jogging just prior to assessment, the increase pulse rate would not add to the score.
Opioid withdrawal should be managed with medical support. In an emergency call 112.
What it measures
The COWS measures the current severity of opioid withdrawal. Its 11 items cover resting pulse rate, gastrointestinal upset, sweating, tremor, restlessness, yawning, pupil size, anxiety or irritability, bone or joint aches, gooseflesh skin, and runny nose or tearing. The total score is the sum of all 11 items, up to 48. According to the form, scores of 5–12 indicate mild, 13–24 moderate, 25–36 moderately severe, and more than 36 severe withdrawal.
When to use it
Clinicians use the COWS to rate opioid withdrawal reproducibly and to monitor it over time, in both inpatient and outpatient settings. The total score helps determine the stage or severity of withdrawal and assess the level of physical dependence on opioids. The clinician rates each item by observing the patient and asking about symptoms, for example measuring the resting pulse or checking pupil size.
Origin
The COWS was published in 2003 by Donald R. Wesson and Walter Ling in the Journal of Psychoactive Drugs.
Limitations
The COWS must be used by trained staff. Items should only be rated on their apparent relationship to opioid withdrawal: for example, a raised pulse after physical activity does not count. Some practitioners are concerned about the objectivity of the items; the developers' introduction notes that patients should not exceed the lowest score in most categories without some observable sign or symptom of withdrawal.
Frequently asked questions
- Who fills in the COWS?
- A clinician, together with the patient. Several items, such as pulse rate, pupil size or tremor, are rated by measuring or observing.
- Is the COWS available in German?
- We do not have a validated German version.
References
- Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35(2):253-259.
- National Institute on Drug Abuse (NIDA). Clinical Opiate Withdrawal Scale.
Licence & attribution
Source: Wesson, D. R., & Ling, W. (2003). The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs, 35(2), 253–9.
"This version may be copied and used clinically." (statement on the form)