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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.

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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.

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