Learning library
Opioid treatment information
What is the Clinical Opiate Withdrawal Scale (COWS)?

What is the Clinical Opiate Withdrawal Scale (COWS)?

We answer your FAQs: what is the COWS scale? Find out about it in this page from Confidant Health.

The Clinical Opiate Withdrawal Scale is a clinically validated method of assessing someone's withdrawal symptoms. It consists of 11 items that allow medical providers to determine how severe a person's opioid dependency is, as well as monitoring the progress of their symptoms over time. These symptoms are: 

1) Resting Pulse Rate: Patients who are going through withdrawal often experience a faster pulse rate. 

2) Sweating: Doctors will ask you whether you are experiencing any chills or flushing and will observe any external indications of changing temperature. 

3) Restlessness: Withdrawal is often accompanied by an inability to sit still. 4) Pupil Size: The level of opioids in your system can cause your pupils to dilate. 

5) Bone or Joint Aches: Bone and muscle pain and aches are common.

6) Runny nose or tearing: Tearing is common during withdrawal. 

7) Gastrointestinal Upset: This can range from mild stomach cramps to regular vomiting and diarrhea. 

8) Tremor: The doctor will ask you to hold out your hands to determine if you are experiencing any tremor or muscle twitching. 

9) Yawning: Another sign that your body is adjusting to the cessation of your substance use. 

10) Anxiety/Irritability: Feelings of anxiety intensify during withdrawal and can be very uncomfortable. 

11) Gooseflesh skin: This is a common reaction in withdrawal.

Book with Confidant

Book with a vetted Confidant Health provider

Book appointment
Request an Enrollment Call

Our team will call you to answer any questions you have or to help you schedule an appointment.

Request an enrollment call
This article has been medically reviewed by
Erin Hillers
Erin Hillers
Erin Hillers
Nurse Practitioner

Erin is a Nurse Practitioner with 8 years of experience in midwifery and women's health. She has spent the past 5 years specializing in the treatment of opioid and alcohol use disorders.

Book appointment
Confidant mobile app screens
Get immediate access to the care you need today

Scan the QR code below to download the app.

QR code to download the app
Download on the App StoreGet it on Google Play