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Clinical Opiate Withdrawal Scale

This document provides a Clinical Opiate Withdrawal Scale (COWS) for measuring and recording symptoms of opiate withdrawal over time during opioid substitution therapy induction. It lists 11 common signs and symptoms of withdrawal and provides a scale of 0-4 to rate the intensity of each symptom. Symptom ratings are totaled to determine overall withdrawal severity as mild, moderate, moderately severe, or severe. The form is to be completed by clinicians at regular intervals to track a patient's progress through withdrawal during opioid agonist induction and stabilization.

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113 views2 pages

Clinical Opiate Withdrawal Scale

This document provides a Clinical Opiate Withdrawal Scale (COWS) for measuring and recording symptoms of opiate withdrawal over time during opioid substitution therapy induction. It lists 11 common signs and symptoms of withdrawal and provides a scale of 0-4 to rate the intensity of each symptom. Symptom ratings are totaled to determine overall withdrawal severity as mild, moderate, moderately severe, or severe. The form is to be completed by clinicians at regular intervals to track a patient's progress through withdrawal during opioid agonist induction and stabilization.

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CPOP

Clinical Opiate Withdrawal Scale (COWS)


Flow-sheet for measuring symptoms over a period of time during OST
induction.
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 increase pulse rate would not add to the score.

Patient’s Name:______________________________________ Date: ______________________


ost induction:
Enter scores at time zero, 30min after first dose, 2hrs after first dose, etc.
Times: ­­ _____ _____ ______ _____
Resting Pulse Rate: (record beats per minute)
Measured after patient is sitting or lying for one minute
0 pulse rate 80 or below
1 pulse rate 81–100
2 pulse rate 101–120
4 pulse rate greater than 120
Sweating: over past ½ hour not accounted for by room
temperature or patient activity.
0 no report of chills or flushing
1 subjective report of chills or flushing
2 flushed or observable moistness on face
3 beads of sweat on brow or face
4 sweat streaming off face
Restlessness Observation during assessment
0 able to sit still
1 reports difficulty sitting still, but is able to do so
3 frequent shifting or extraneous movements of legs/arms
5 Unable to sit still for more than a few seconds
Pupil size
0 pupils pinned or normal size for room light
1 pupils possibly larger than normal for room light
2 pupils moderately dilated
5 pupils so dilated that only the rim of the iris is visible
Bone or Joint aches If patient was having pain previously,
only the additional component attributed to opiates
withdrawal is scored
0 not present
1 mild diffuse discomfort
2 patient reports severe diffuse aching of joints/muscles
4p atient is rubbing joints or muscles and is unable to sit still
because of discomfort

Clinical Policies and Procedures for the Use of Methadone and Buprenorphine in the Treatment of Opioid Dependence
Runny nose or tearing Not accounted for by cold symptoms
or allergies
0 not present
1 nasal stuffiness or unusually moist eyes
2 nose running or tearing
4 nose constantly running or tears streaming down cheeks
GI Upset: over last ½ hour
0 no GI symptoms
1 stomach cramps
2 nausea or loose stool
3 vomiting or diarrhea
5 Multiple episodes of diarrhea or vomiting
Tremor observation of outstretched hands
0 No tremor
1 tremor can be felt, but not observed
2 slight tremor observable
4 gross tremor or muscle twitching
Yawning Observation during assessment
0 no yawning
1 yawning once or twice during assessment
2 yawning three or more times during assessment
4 yawning several times/minute
Anxiety or Irritability
0 none
1 patient reports increasing irritability or anxiousness
2 patient obviously irritable anxious
4 patient so irritable or anxious that participation in the
assessment is difficult
Gooseflesh skin
0 skin is smooth
3 piloerrection of skin can be felt or hairs standing up on arms
5 prominent piloerrection
Total scores ­­­­­ ­­­­­ ­­­­­ ­­­­­
with observer’s initials

Score:
5–12 = mild;
13–24 = moderate;
25–36 = moderately severe;
more than 36 = severe withdrawal

Clinical Policies and Procedures for the Use of Methadone and Buprenorphine in the Treatment of Opioid Dependence

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