Clinical opioid withdrawal scale: Difference between revisions

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==Criteria==
==Criteria==
{| class="wikitable"
{| class="wikitable"
! Criterion
!Criterion
! 0
!0
! 1
!1
! 2
!2
! 3
!3
! 4
!4
! 5
!5
|-
|-
| '''Resting pulse rate'''<br/>(measured after sitting or lying for 1 minute)
|'''Resting pulse rate'''<br />(measured after sitting or lying for 1 minute)
| ≤80
|≤80
| 81-100
|81-100
| 101-120
|101-120
| >120
|>120
|
|
|-
|-
| '''Sweating'''<br/>(not accounted for by ambient temperature or recent activity)
|'''Sweating'''<br />(not accounted for by ambient temperature or recent activity)
| No report of chills or lushing
|No report of chills or lushing
| Subjective report of chills or flushing
|Subjective report of chills or flushing
| Flushed or observable moistness on face
|Flushed or observable moistness on face
| Beads of sweat on brow or face
|Beads of sweat on brow or face
| Sweat streming off face
|Sweat streming off face
|
|
|-
|-
| '''Restlessness'''<br/>(observable during assessment)
|'''Restlessness'''<br />(observable during assessment)
| Able to sit still
|Able to sit still
| Reports difficulty sitting still, but is able to do so
|Reports difficulty sitting still, but is able to do so
|
|
| Frequent shifting or extraneous movements of legs/arms
|Frequent shifting or extraneous movements of legs/arms
|
|
| Unable to sit still for more than a few seconds
|Unable to sit still for more than a few seconds
|-
|-
| '''Pupil size'''
|'''Pupil size'''
| Pupils pinned or normal size for room light
|Pupils pinned or normal size for room light
| Pupils possibly larger than normal for room light
|Pupils possibly larger than normal for room light
| Pupils moderately dilated
|Pupils moderately dilated
⚫
|
|
|
⚫
|
| Pupils so dilated that only the rim of the iris is visible
|Pupils so dilated that only the rim of the iris is visible
|-
|-
| '''Bone or joint aches'''<br/>(only the portion attributed to opioid withdrawal)
|'''Bone or joint aches'''<br />(only the portion attributed to opioid withdrawal)
| Not present
|Not present
| Mild diffuse discomfort
|Mild diffuse discomfort
| Patient reports severe diffuse aching of joints/muscles
|Patient reports severe diffuse aching of joints/muscles
|
|
| Patient is rubbing joints or muscles and is unable to sit still because of discomfort
|Patient is rubbing joints or muscles and is unable to sit still because of discomfort
|
|
|-
|-
| '''Runny nose or tearing'''<br/>(not accounted for by cold or allergies)
|'''Runny nose or tearing'''<br />(not accounted for by cold or allergies)
| Not present
|Not present
| Nasal stuffiness or unusually moist eyes
|Nasal stuffiness or unusually moist eyes
| Nose running or tearing
|Nose running or tearing
⚫
|
⚫
|Nose constantly running or tears streaming down cheeks
|
|
⚫
| Nose constantly running or tears streaming down cheeks
⚫
|
|-
|-
| '''GI upset'''<br/>(over last half hour)
|'''GI upset'''<br />(over last half hour)
| No GI symptoms
|No GI symptoms
| Stomach cramps
|Stomach cramps
| Nausea or loose stool
|Nausea or loose stool
| Vomiting or diarrhea
|Vomiting or diarrhea
|
|
| Multiple episodes of vomiting or diarrhea
|Multiple episodes of vomiting or diarrhea
|-
|-
| '''Tremor'''<br/>(observable of outstretched hands)
|'''Tremor'''<br />(observable of outstretched hands)
| No tremor
|No tremor
| Tremor can be felt, but not observed
|Tremor can be felt, but not observed
| Slight tremor observable
|Slight tremor observable
|
|
| Gross tremor or muscle twitching
|Gross tremor or muscle twitching
|
|
|-
|-
| '''Yawning'''<br/>(observable during assessment)
|'''Yawning'''<br />(observable during assessment)
| No yawning
|No yawning
| Yawning once or twice during assessment
|Yawning once or twice during assessment
| Yawning three or more times during assessment
|Yawning three or more times during assessment
|
|
| Yawning several times per minute
|Yawning several times per minute
|
|
|-
|-
| '''Anxiety or irritability'''
|'''Anxiety or irritability'''
| None
|None
| Patient reports increasing irritability or anxiousness
|Patient reports increasing irritability or anxiousness
| Patient obviously irritable/anxious
|Patient obviously irritable/anxious
|
|
| Patient so irritable or anxious that participation in the assessment is difficult
|Patient so irritable or anxious that participation in the assessment is difficult
|
|
|-
|-
| '''Gooseflesh skin'''
|'''Gooseflesh skin'''
| Skin is smooth
|Skin is smooth
|
|
|
|
| Piloerection of skin can be felt or hairs standing up on arms
|Piloerection of skin can be felt or hairs standing up on arms
|
|
| Prominent piloerection
|Prominent piloerection
|-
!Criterion
!0
!1
!2
!3
!4
!5
|}
|}


==Interpretation==
==Interpretation==

* Mild: 5-12
* Moderate: 13-24
*Mild: 5-12
*Moderate: 13-24
* Moderately- sever: 25-36
*Moderately severe: 25-36
* Severe: more than 36
*Severe: more than 36


==Further Reading==
==Further Reading==

* 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]
*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]


[[Category:Addiction medicine]]
[[Category:Addiction medicine]]

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

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