COWS (Clinical Opiate Withdrawal Scale)

Clinician-administered scale that rates opioid (opiate) withdrawal severity at a point in time by summing 11 observed signs and symptoms, scoring only findings attributable to withdrawal and repeating over time to track the trajectory.

Resting pulse rate (after sitting or lying 1 minute)

Sweating (over past 1/2 hour, not from room temperature or activity)

Restlessness (observed during assessment)

Pupil size

Bone or joint aches (if pre-existing pain, score only the additional withdrawal component)

Runny nose or tearing (not from cold symptoms or allergies)

GI upset (over last 1/2 hour)

Tremor (observation of outstretched hands)

Yawning (observed during assessment)

Anxiety or irritability

Gooseflesh skin