COWS
ValidatedClinical Opiate Withdrawal Scale (COWS)
Adults (18+)Clinician~5 min11 questions
For each item, circle the number that best describes the patient’s signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient was jogging just prior to assessment, the increase pulse rate would not add to the score.
Report details · optional
Shown on the report and stored with the screening record. Use initials or a code, not full names.
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About this screener — evidence, source
An 11-item clinician-administered scale that rates common signs and symptoms of opioid withdrawal, for use in inpatient and outpatient settings. The summed score helps determine the stage or severity of withdrawal — for example before starting buprenorphine — and can be repeated to monitor symptoms over time.
Evidence · validated
In a double-blind naloxone-challenge study of 46 opioid-dependent volunteers, peak COWS scores correlated strongly with the validated Clinical Institute Narcotic Assessment (Pearson r = 0.85), and both were judged valid measures of acute opioid withdrawal (Tompkins et al., 2009). Severity ranges are those published with the scale.
Source & licence
Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35(2):253–259. Tompkins DA, Bigelow GE, Harrison JA, et al. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009;105(1–2):154–159.
Licence: Free for clinical use — the published form states: “This version may be copied and used clinically.”
Clinical use; distributed by NIDA. Wording transcribed from the NIDA copy of the Wesson & Ling (2003) appendix.
Official source ↗