Clinical Opioid Withdrawal Scale, COWS Test - the question form
Questions: 11 · 3 minutes
1. Resting pulse rate (beats per minute). Measure after the patient has been sitting or lying down for one minute.
0: pulse rate 80 or less
1: pulse rate 81–100
2: pulse rate 101–120
4: pulse rate greater than 120
2. Sweating: over the past half-hour, not due to room temperature or physical activity.
0: No report of chills or flushing
1: Subjective report of chills or flushing
2: Flushed or visibly moist face
3: Beads of sweat on the forehead or face
4: Sweat streaming down the face
3. Restlessness: observation during assessment
0: Able to sit still
1: Reports difficulty sitting still, but is able to do so
3: Frequent shifting of position or extraneous movements of legs/arms
5: Unable to sit still for more than a few seconds
4. Pupil size
0: Pupils constricted 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
5. Bone or joint aches: if the patient had pain prior to withdrawal, score only the additional component attributable to opioid withdrawal
0: Not present
1: Mild diffuse discomfort
2: Patient reports severe diffuse aching of joints/muscles
4: Patient rubs joints or muscles and is unable to sit still due to discomfort
6. Runny nose or tearing (not due to a cold or allergies)
0: None
1: Nasal stuffiness or unusually watery eyes
2: Excessive runny nose or tearing
4: Constant runny nose or tears running down the cheeks
7. Gastrointestinal upset: over the last 30 minutes
0: No GI symptoms
1: Stomach cramps
2: Nausea or loose stool
3: Vomiting or diarrhea
5: Multiple episodes of diarrhea or vomiting
8. 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
9. Yawning: observation during assessment
0: no yawning
1: yawned once or twice during assessment
2: yawned three or more times during assessment
4: yawning several times per minute
10. Anxiety or irritability
0: none
1: patient reports increasing irritability or fear
2: patient is obviously irritable or in severe fear
4: patient is so irritable or in such severe fear that further participation in the assessment is difficult
11. Gooseflesh (piloerection)
0: skin is smooth
3: piloerection can be felt, or hairs are standing up on the arms
5: piloerection is obvious