💊 COWS (Opioid Withdrawal)
Grade opioid withdrawal severity with the Clinical Opiate Withdrawal Scale (COWS).
COWS (Opioid Withdrawal)
Resting pulse rate
Sweating
Restlessness
Pupil size
Bone/joint aches
Runny nose/tearing
GI upset
Tremor
Yawning
Anxiety/irritability
Gooseflesh skin
When to use
Time buprenorphine induction and manage opioid withdrawal.
How it works
Eleven items summed: 5–12 mild, 13–24 moderate, 25–36 moderately severe, > 36 severe.
Key points
- Objective withdrawal (often COWS ≥ 8–12) should precede buprenorphine.
- Premature dosing risks precipitated withdrawal.
- Reassess frequently during induction.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.