Advanced Search
Discover new calcs: choose 1 function + 1 more filter
Examples:
Click here to discover
Pulmonary Embolism
calculators for
Diagnosis
After you diagnose a PE, discover
Pulmonary Embolism
calculators for
Prognosis

    Calc Function

  • Calcs that help predict probability of a diseaseDiagnosis
  • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
  • Disease is diagnosed: prognosticate to guide treatmentPrognosis
  • Numerical inputs and outputsFormula
  • Med treatment and moreTreatment
  • Suggested protocolsAlgorithm

Disease

Select...

Specialty

Select...

Chief Complaint

Select...

Organ System

Select...

COWS Score for Opiate Withdrawal

Quantifies severity of opiate withrawal.

Advice

Using COWS in buprenorphine induction treatment:

  • Buprenorphine is a partial opiate agonist that can precipitate florid opiate withdrawal if administered to a physically-dependent patient.
  • In buprenorphine induction, it is important that a patient is already in mild to moderate opiate withdrawal prior to administration. This would be equivalent to a COWS score >5-6 (>10 preferable).
  • This is important as otherwise patients experience precipitated withdrawal, a rapid and intense onset of withdrawal symptoms initiated by the medication.
  • It is not reliable to use “time since last opioid use” since patients are not always truthful in reporting their last use, and metabolism varies from patient to patient.

Management

  • COWS can help set patient expectations prior to buprenorphine treatment, as they will likely experience a certain amount of discomfort.
  • Opioid detoxification works best with adjunctive treatments such as psychotherapy and support groups.

Critical Actions

Always consider the possibility of comorbid withdrawal conditions from alcohol, benzodiazepine, or sedative-hypnotics, which may be life threatening alone or in combination.