COWS (opioid withdrawal)
COWS (opioid withdrawal) - a deterministic tool in Sophie Well's Clinical Scoring & Risk group.
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What this is
Score the Clinical Opiate Withdrawal Scale (Wesson 2003) across its 11 observed and reported items - resting pulse, sweating, restlessness, pupil size, bone or joint aches, runny nose, GI upset, tremor, yawning, anxiety, and gooseflesh skin. Sophie Well sums the items to a 0-48 total and returns the published severity band: mild (5-12), moderate (13-24), moderately severe (25-36), or severe (>=37).
When to use it
Use this at induction onto buprenorphine to confirm objective withdrawal before the first dose (typically COWS >=8-12 per the SAMHSA TIP 63 induction protocol), or to track withdrawal severity during inpatient opioid taper. The score is an aid to clinical judgment, not a substitute for it; precipitated withdrawal can still occur even when COWS is in the expected range.
References
Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35(2):253-259.
Worked example: COWS 15 (moderate withdrawal).
Sophie Well is a reference and educational tool. Not medical, legal, or financial advice. Does not replace clinician judgment, professional billing review, or legal counsel.