Clinical opioid withdrawal scale: Difference between revisions
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See also [https://www.mdcalc.com/cows-score-opiate-withdrawal MDCalc COWS score] |
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==Criteria== |
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{| class="wikitable" |
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!Criterion |
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!0 |
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!1 |
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!2 |
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!3 |
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!4 |
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!5 |
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|'''Resting pulse rate'''<br />(measured after sitting or lying for 1 minute) |
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|≤80 |
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|81-100 |
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|101-120 |
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|>120 |
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|'''Sweating'''<br />(not accounted for by ambient temperature or recent activity) |
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|No report of chills or lushing |
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|Subjective report of chills or flushing |
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|Flushed or observable moistness on face |
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|Beads of sweat on brow or face |
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|Sweat streming off face |
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|'''Restlessness'''<br />(observable during assessment) |
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|Able to sit still |
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|Reports difficulty sitting still, but is able to do so |
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|Frequent shifting or extraneous movements of legs/arms |
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|Unable to sit still for more than a few seconds |
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|'''Pupil size''' |
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|Pupils pinned or normal size for room light |
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|Pupils possibly larger than normal for room light |
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|Pupils moderately dilated |
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|Pupils so dilated that only the rim of the iris is visible |
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|'''Bone or joint aches'''<br />(only the portion attributed to opioid withdrawal) |
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|Not present |
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|Mild diffuse discomfort |
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|Patient reports severe diffuse aching of joints/muscles |
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|Patient is rubbing joints or muscles and is unable to sit still because of discomfort |
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|'''Runny nose or tearing'''<br />(not accounted for by cold or allergies) |
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|Not present |
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|Nasal stuffiness or unusually moist eyes |
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|Nose running or tearing |
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|Nose constantly running or tears streaming down cheeks |
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|'''GI upset'''<br />(over last half hour) |
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|No GI symptoms |
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|Stomach cramps |
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|Nausea or loose stool |
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|Vomiting or diarrhea |
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|Multiple episodes of vomiting or diarrhea |
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|'''Tremor'''<br />(observable of outstretched hands) |
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|No tremor |
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|Tremor can be felt, but not observed |
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|Slight tremor observable |
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|Gross tremor or muscle twitching |
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|'''Yawning'''<br />(observable during assessment) |
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|No yawning |
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|Yawning once or twice during assessment |
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|Yawning three or more times during assessment |
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|Yawning several times per minute |
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|'''Anxiety or irritability''' |
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|None |
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|Patient reports increasing irritability or anxiousness |
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|Patient obviously irritable/anxious |
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|Patient so irritable or anxious that participation in the assessment is difficult |
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|'''Gooseflesh skin''' |
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|Skin is smooth |
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|Piloerection of skin can be felt or hairs standing up on arms |
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|Prominent piloerection |
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|- |
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!Criterion |
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!0 |
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!1 |
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!2 |
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!3 |
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!4 |
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!5 |
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|} |
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==Interpretation== |
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*Mild: 5-12 |
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*Moderate: 13-24 |
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*Moderately severe: 25-36 |
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*Severe: more than 36 |
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==Further Reading== |
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*The Clinical Opiate Withdrawal Scale (COWS). ''J Psychoactive Drugs''. 2003;35(2):253-259. doi: [https://doi.org/10.1080/02791072.2003.10400007 10.1080/02791072.2003.10400007] |
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[[Category:Addiction medicine]] |
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Latest revision as of 15:43, 20 February 2022
See also MDCalc COWS score
Criteria
| Criterion | 0 | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|---|
| Resting pulse rate (measured after sitting or lying for 1 minute) |
≤80 | 81-100 | 101-120 | >120 | ||
| Sweating (not accounted for by ambient temperature or recent activity) |
No report of chills or lushing | Subjective report of chills or flushing | Flushed or observable moistness on face | Beads of sweat on brow or face | Sweat streming off face | |
| Restlessness (observable during assessment) |
Able to sit still | Reports difficulty sitting still, but is able to do so | Frequent shifting or extraneous movements of legs/arms | Unable to sit still for more than a few seconds | ||
| Pupil size | Pupils pinned or normal size for room light | Pupils possibly larger than normal for room light | Pupils moderately dilated | Pupils so dilated that only the rim of the iris is visible | ||
| Bone or joint aches (only the portion attributed to opioid withdrawal) |
Not present | Mild diffuse discomfort | Patient reports severe diffuse aching of joints/muscles | Patient is rubbing joints or muscles and is unable to sit still because of discomfort | ||
| Runny nose or tearing (not accounted for by cold or allergies) |
Not present | Nasal stuffiness or unusually moist eyes | Nose running or tearing | Nose constantly running or tears streaming down cheeks | ||
| GI upset (over last half hour) |
No GI symptoms | Stomach cramps | Nausea or loose stool | Vomiting or diarrhea | Multiple episodes of vomiting or diarrhea | |
| Tremor (observable of outstretched hands) |
No tremor | Tremor can be felt, but not observed | Slight tremor observable | Gross tremor or muscle twitching | ||
| Yawning (observable during assessment) |
No yawning | Yawning once or twice during assessment | Yawning three or more times during assessment | Yawning several times per minute | ||
| Anxiety or irritability | None | Patient reports increasing irritability or anxiousness | Patient obviously irritable/anxious | Patient so irritable or anxious that participation in the assessment is difficult | ||
| Gooseflesh skin | Skin is smooth | Piloerection of skin can be felt or hairs standing up on arms | Prominent piloerection | |||
| Criterion | 0 | 1 | 2 | 3 | 4 | 5 |
Interpretation
- Mild: 5-12
- Moderate: 13-24
- Moderately severe: 25-36
- Severe: more than 36
Further Reading
- The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35(2):253-259. doi: 10.1080/02791072.2003.10400007
