SSweeney Practicum

Psychiatry / Addiction Medicine

COWS Score Calculator

Clinical Opiate Withdrawal Scale — score all 11 items to grade opioid withdrawal severity.

1. Resting Pulse Rate (beats/minute)
2. Sweating (over past ½ hour, not from activity or room temperature)
3. Restlessness (observation during assessment)
4. Pupil Size
5. Bone or Joint Aches (if patient was having pain previously, only additional withdrawal component)
6. Runny Nose or Tearing (not accounted for by cold or allergies)
7. GI Upset (over last ½ hour)
8. Tremor (observation of outstretched hands)
9. Yawning (observation during assessment)
10. Anxiety or Irritability
11. Gooseflesh Skin
Total COWS score
00/11 items answered
No significant withdrawal

Answer all 11 items for a complete assessment.

Scoring reference

  • 5–12: Mild withdrawal
  • 13–24: Moderate withdrawal
  • 25–36: Moderately severe withdrawal
  • >36: Severe withdrawal

Educational tool. Clinical decisions require full patient context.