COWS Score for Opiate Withdrawal
Quantifies severity of opiate withdrawal.
When to Use
Pearls/Pitfalls
Why Use
≤80
081-100
+1101-120
+2>120
+4No report of chills or flushing
0Subjective report of chills or flushing
+1Flushed or observable moistness on face
+2Beads of sweat on brow or face
+3Sweat streaming off face
+4Able to sit still
0Reports difficulty sitting still, but is able to do so
+1Frequent shifting or extraneous movements of legs/arms
+3Unable to sit still for more than a few seconds
+5Pupils pinned or normal size for room light
0Pupils possibly larger than normal for room light
+1Pupils moderately dilated
+2Pupils so dilated that only the rim of the iris is visible
+5Not present
0Mild diffuse discomfort
+1Patient reports severe diffuse aching of joints/ muscles
+2Patient is rubbing joints or muscles and is unable to sit still because of discomfort
+4Not present
0Nasal stuffiness or unusually moist eyes
+1Nose running or tearing
+2Nose constantly running or tears streaming down cheeks
+4No GI symptoms
0Stomach Cramps
+1Nausea or loose stool
+2Vomiting or diarrhea
+3Multiple episodes of vomiting or diarrhea
+5No tremor
0Tremor can be felt, but not observed
+1Slight tremor observable
+2Gross tremor or muscle twitching
+4No yawning
0Yawning once or twice during assessment
+1Yawning three or more times during assessment
+2Yawning several times/minute
+4None
0Patient reports increasing irritability or anxiousness
+1Patient obviously irritable/anxious
+2Patient so irritable or anxious that participation in the assessment is difficult
+4Skin is smooth
0Piloerection of skin can be felt or hairs standing up on arms
+3Prominent piloerection
+5Result:
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