COWS (Opiate Withdrawal)

Score each of eleven domains 0–5; sum 0–48 with mild, moderate, moderately severe, or severe bands.

Rate each sign/symptom 0–5 per the COWS anchor definitions.

Resting pulse rate (record beats per minute)

Sweating over past ½ hour not accounted for by room temperature or activity

Restlessness observation during assessment

Pupil size

Bone or joint aches (if patient was having pain previously, only the additional component attributed to opiates withdrawal is scored)

Runny nose or tearing (not accounted for by cold symptoms or allergies)

GI upset over last ½ hour (may include nausea/vomiting, stomach cramps, diarrhea, etc.)

Tremor observation of outstretched hands

Yawning observation during assessment

Anxiety or irritability

Gooseflesh skin

Educational tool only—not for diagnosis or treatment decisions.

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