What are the limitations of the COWS (Opioid Withdrawal)?

While the COWS (Opioid Withdrawal) is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the COWS (Opioid Withdrawal) to ensure safe bedside use and optimal diagnostic accuracy.

How does the COWS (Opioid Withdrawal) compare to other Psychiatry scores?

The COWS (Opioid Withdrawal) is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the COWS (Opioid Withdrawal) free to use?

Yes. OpiCalc provides the COWS (Opioid Withdrawal) completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

COWS (Opioid Withdrawal)

COWS: Clinical Opiate Withdrawal Scale. 11-item clinician-administered assessment. COWS ≥ 8–12 typically required before initiating buprenorphine to avoid precipitated withdrawal.

Resting Pulse Rate (bpm)

Measure after patient has been sitting or lying for 1 minute.

Sweating

Observe. Not accounted for by room temperature or patient activity over the past 0.5 hour.

Restlessness

Observation during assessment.

Pupil Size

Observe.

Bone or Joint Aches

If the patient was having pain previously, only the additional component attributed to opioid withdrawal is scored.

Runny Nose or Tearing

Not accounted for by cold symptoms or allergies.

GI Upset

Over the last 0.5 hour.

Tremor

Observe. Hands outstretched.

Yawning

Observe.

Anxiety or Irritability

Observe.

Goosebumps / Piloerection

Observe skin on arms.

No clinical reference data available.

COWS (Opioid Withdrawal)

COWS: Clinical Opiate Withdrawal Scale. 11-item clinician-administered assessment. COWS ≥ 8–12 typically required before initiating buprenorphine to avoid precipitated withdrawal.

Resting Pulse Rate (bpm)

Measure after patient has been sitting or lying for 1 minute.

Sweating

Observe. Not accounted for by room temperature or patient activity over the past 0.5 hour.

Restlessness

Observation during assessment.

Pupil Size

Observe.

Bone or Joint Aches

If the patient was having pain previously, only the additional component attributed to opioid withdrawal is scored.

Runny Nose or Tearing

Not accounted for by cold symptoms or allergies.

GI Upset

Over the last 0.5 hour.

Tremor

Observe. Hands outstretched.

Yawning

Observe.

Anxiety or Irritability

Observe.

Goosebumps / Piloerection

Observe skin on arms.

No clinical reference data available.