Clinical opioid withdrawal scale
From IDWiki
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 |
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
