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Clinical Opioid Withdrawal Scale

Aka: Clinical Opioid Withdrawal Scale, COWS
  1. Indications
    1. Opioid Withdrawal Evaluation
    2. Initiation of medication assisted therapy (MAT) for Opioid Dependence
  2. Criteria
    1. Resting Pulse Rate (after sitting or lying for 1 minute)
      1. Score 0: Pulse 80 or less
      2. Score 1: Pulse 81-100
      3. Score 2: Pulse 101-120
      4. Score 4: Pulse >120
    2. Sweats during prior 30 minutes (aside from activity, Ambient Temperature)
      1. Score 0: No chills or Flushing
      2. Score 1: Subjective chills or Flushing
      3. Score 2: Flushed or moisture seen on face
      4. Score 3: Sweat beads on brow or face
      5. Score 4: Sweats streams from face
    3. Restlessness
      1. Score 0: Able to sit still
      2. Score 1: Subjectively feels as if cannot sit still (but not observed)
      3. Score 3: Frequently shifts position, or moves arms or legs
      4. Score 5: Unable to sit still for more than a few seconds
    4. Pupil size
      1. Score 0: Pin-head, constricted pupils (Miosis) or normal for room light
      2. Score 1: Borderline Pupil Dilation (Mydriasis) for room light
      3. Score 2: Moderate Pupil Dilation (Mydriasis)
      4. Score 5: Severe Pupil Dilation (Mydriasis) with only a rim of iris remaining
    5. Bone or Joint aches (beyond baseline pain)
      1. Score 0: None
      2. Score 1: Mild diffuse discomfort
      3. Score 2: Subjective report of severe diffuse joint or muscle aches
      4. Score 4: Pain results in patient rubbing joints, and is unable to sit still
    6. Runny nose or eye tearing (aside from Upper Respiratory Infection or Allergic Rhinitis)
      1. Score 0: None
      2. Score 1: Nasal congestion or eyes moist
      3. Score 2: Nose runs or eyes tear
      4. Score 4: Constant nasal drainage or constant eye tearing down cheeks
    7. Gastrointestinal upset during prior 30 minutes
      1. Score 0: None
      2. Score 1: Stomach cramps
      3. Score 2: Nausea or loose stools
      4. Score 3: Vomiting or Diarrhea
      5. Score 5: Multiple episodes of Vomiting or Diarrhea
    8. Tremor with outstretched hands
      1. Score 0: None
      2. Score 1: Subjective Tremors not seen on exam
      3. Score 2: Mild Tremor
      4. Score 4: Gross Tremor or muscle twitching
    9. Yawning
      1. Score 0: None
      2. Score 1: Patient yawns 1-2 times during evaluation
      3. Score 2: Patient yawns several times during evaluation
      4. Score 4: Patient yawns several times each minute
    10. Anxiety or Irritability
      1. Score 0: None
      2. Score 1: Subjective sense of increasing irritability or anxiousness
      3. Score 2: Observed irritability or anxiousness
      4. Score 4: Irritability or anxiousness interferes with evaluation
    11. Gooseflesh Skin
      1. Score 0: Smooth skin
      2. Score 3: Palpable piloerection or arm hairs stand up
      3. Score 5: Prominent piloerection
  3. Interpretation
    1. Score 5-12: Mild Opioid Withdrawal
    2. Score 13-24: Moderate Opioid Withdrawal
    3. Score 25-36: Moderately Severe Opioid Withdrawal
    4. Score >26: Severe Opioid Withdrawal
  4. References
    1. Wesson (2003) J Psychoactive Drugs 35(2): 253–9 [PubMed]

COWS Questionnaire Question (C3640279)

Definition (NCI) A question associated with the COWS questionnaire.
Concepts Intellectual Product (T170)
English COWS Questionnaire Question
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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