Clinical Opiate Withdrawal Scale (COWS) | National Institute on Drug Abuse (NIDA)

description of resource

The Clinical Opiate Withdrawal Scale (COWS) is an 11‑item clinician‑administered tool used to assess common signs and symptoms of opioid withdrawal and track their progression over time. It produces a summed score that helps determine the severity of withdrawal and the level of physical dependence.

who might use it

Clinicians, nurses, and medical staff in inpatient or outpatient settings use the COWS to evaluate withdrawal severity, guide treatment decisions, and monitor symptom changes. It is especially relevant in settings where opioid withdrawal management or medication initiation is being considered.

how to use it

A clinician rates each of the 11 items, such as pulse, sweating, restlessness, pupil size, and gastrointestinal upset, based on direct observation and patient report, then adds the scores to produce a total. The total score is interpreted using established ranges (mild, moderate, moderately severe, or severe withdrawal) to inform clinical decision‑making.