COWS - Clinical Opiate Withdrawal Scale


The Clinical Opiate Withdrawal Scale (COWS) is a clinician-administered instrument that rates eleven common opiate withdrawal signs or symptoms. The summed score of the eleven items can be used to assess a patient's level of opiate withdrawal and to make inferences about their level of physical dependence on opioids.

Special Instructions

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 would not add to the score.

Scores Produced

COWS Total (0-48)


  • 5-12 = mild
  • 13-24 = moderate
  • 25-36 = moderately severe
  • >36 = severe withdrawal


Wesson DR, Ling W, The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003 Apr-Jun; 35(2):253-9.



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