COWS Clinical Opiate Withdrawal Scale

For each item, write in 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 increased pulse rate would not add to the score. For opiate induction: enter scores at time zero, 30 minutes after first dose, 2 hours after first dose, etc..

Name *This question is required.

Name of My Therapist *This question is required. Who is it who has asked you to fill out this form? - choose one

Date of Rating *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Time of Rating

Resting Heart Rate Record beats per minute. Measured after patient is sitting or lying for one minute. This question requires a valid number format.

Score for Resting Heart Rate *This question is required.

Score for Sweating *This question is required. Over Past 1/2 Hour not Accounted for by Room Temperature or Patient Activity

Score for Restlessness *This question is required. Observation During Assessment

Score for Pupil Size *This question is required.

Score for New Aches *This question is required. Bone or Joint Aches if Patient was Having Pain Previously, only the Additional Component Attributed to Opiate Withdrawal is Scored

Score for Runny Nose or Tearing *This question is required. Runny Nose or Tearing Not Accounted for by Cold Symptoms or Allergies

Score for GI Upset *This question is required. GI Upset: Over Last 1/2 Hour

Score for Tremor *This question is required. Tremor Observation of Outstretched Hands

Score for Yawning *This question is required. Yawning Observation During Assessment

Score for Anxiety or Irritability *This question is required. Anxiety or Irritability

Score for Gooseflesh
*This question is required.