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Clinical Opiate Withdrawal Scale (COWS)

Clinical Opiate Withdrawal Scale (COWS) Test

Gauge opioid withdrawal severity in about 3 minutes. Eleven clinical signs yield a clear score to guide care decisions fast and track improvement over time.

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Questions: 113 minutes

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08:30

October 2, 2025

October 2, 2025
Material has been updated

October 2, 2025
Material has been published

17675 views

1170 completions

981 likes

Scale Explorer

How the Scales are Structured

example score

28/48

Withdrawal Severity Scale (WSS)

Measures the severity of opioid withdrawal signs and symptoms based on observed and reported indicators.

Mild–Moderate

Moderately Severe

Severe

5 – 24: Mild–Moderate | 25 – 36: Moderately Severe | 37 – 48: Severe

A score of 28 falls in the Moderately Severe range, indicating more pronounced withdrawal symptoms on this scale.

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DATA-BASED USER COHORTS

Who Usually Takes This Test?

ED and inpatient clinicians

46%OF USERS

Doctors and nurses in emergency or hospital units use it to quickly score withdrawal severity and guide immediate treatment decisions.

Addiction treatment providers

34%OF USERS

Clinicians in detox and opioid use disorder programs use it to track symptoms over time and adjust medications like buprenorphine safely.

Outpatient primary care teams

20%OF USERS

Primary care and community clinic staff use it to assess patients starting or restarting treatment and decide when higher-level care is needed.

BASED ON AGGREGATED, ANONYMIZED DATA FROM TENS OF THOUSANDS OF FREUDLY USERS.

RESULTS YOU CAN ACTUALLY USE

What You’ll See After You Finish the Test

Scale Results
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Statistical
Comparison

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AI-Detected
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Key patterns you might not notice on your own. Surfacing subtle connections in your responses that help you better understand what may be driving your current results.

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Used in 52+ countries

Benchmarking

See How You Compare

Once you finish the test, your results will be compared with real-world data from people in your country.
Below is a preview of the benchmarks we use to place your score in context.

Severity Scale of Condition (SSoC)

Average

25.3

Normal range

18.6 — 31.9

min.

max.

majority

This curve shows how scores are typically distributed.
Once you complete the test, your result will appear here so you can see where you land.

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CLEAR ANSWERS TO COMMON QUESTIONS

Frequently Asked Questions

Any questions left?

What does this scale measure?

It rates the current severity of opioid withdrawal signs and symptoms. The score helps guide immediate clinical decisions and ongoing monitoring.

Who completes the rating?

A trained clinician completes it using direct observation and brief patient questions. Self-administration is not intended.

What types of signs and symptoms are included?

Items cover observable and measurable withdrawal features such as sweating, tremor, restlessness, pupil size, gastrointestinal upset, and vital signs. Each item is scored using defined anchors.

How long does it take to complete?

Completion typically takes about 3 minutes. Timing may vary if additional vital sign checks are needed.

How should the score be interpreted?

Higher scores indicate more severe withdrawal at the time of assessment. The score should be interpreted with clinical judgment and the overall presentation.

WHAT THE TEST MEASURES

About This Assessment

Clinical Opioid Withdrawal Scale, COWS Test

Clinical Opiate Withdrawal Scale (COWS) Test

addiction medicine drug addiction

This measure is used to support rapid, structured assessment of opioid withdrawal severity in clinical settings. The Clinical Opiate Withdrawal Scale (COWS) is a clinician-rated instrument that combines observation with brief inquiry to quantify key withdrawal signs and symptoms.

It consists of 11 items and typically requires about 3 minutes to complete. Ratings are summed to provide an overall withdrawal severity score that can help guide clinical decision-making and track change over time. The Clinical Opiate Withdrawal Scale (COWS) was developed by Ling and Wesson.

Author: Ling, W., Wesson, D.

Literature: Wesson, D. R., & Ling, W. The Clinical Opiate Withdrawal Scale (COWS). Journal of Psychoactive Drugs. 2003.

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