Clinical Opiate Withdrawal Scale (COWS)

Parameters

Findings

Points

resting pulse rate

<= 80

0

81 to 100

1

101 to 120

2

> 120

4

sweating and/or chills

none

0

subjective report

1

flushed or observable moisture on face

2

beads of sweat on brow or face

3

sweat streaming off face

4

restlessness

able to sit still

0

difficulty sitting still but able to

1

frequently shifting or extraneous movement of limbs

3

unable to sit still for more than a few seconds

5

pupil size

pinned or normal size for room light

0

possibly larger than normal for room light

1

moderately dilated

2

dilated with only the rim of the iris is visible

5

bone and/or joint aches

none

0

mild, diffuse

1

severe diffuse aching

2

rubbing joints or muscles; unable to still because of discomfort

4

runny nose and/or tearing

none

0

nasal stuffiness or unusually moist eyes

1

nose running or tearing

2

nose constantly running or tears streaming down face

4

GI upset

none

0

stomach cramps

1

nausea or loose stool

2

vomiting or diarrhea

3

multiple episodes of diarrhea or vomiting

5

tremor

none

0

felt but not observed

1

slight tremor observed

2

gross tremor or muscle twitching

4

yawning

no yawning

0

yawns once or twice during assessment

1

yawns >= 3 times

2

yawns several times per minute

4

anxiety and/or irritability

none

0

increasing irritability or anxiousness

1

obviously irritable or anxious

2

participation difficult due to anxiety or irritability

4

gooseflesh

skin is smooth

0

piloerection of skin or hairs standing up on arms

3

prominent piloerection

5

Total Score

Withdrawal

0 to 4

none or minimal

5 to 12

mild

13 to 24

moderate

25 to 36

moderate to severe

37 to 48

severe