Clinical Opiate Withdrawal Scale

Original/alternative title:  COWS


Clinician-administered, pen and paper flow-sheet for measuring symptoms over a period of time during buprenorphine induction.

It measures 11 physical opioid withdrawal symptoms over time including resting pulse rate, gastrointestinal upset, sweating, tremor, restlessness, yawning, pupil size, anxiety and irritability, bone or joint aches, goosebumps, runny nose or watering eyes.

Additional information

Wesson, D. R., & Ling, W. (2003). The Clinical Opiate Withdrawal Scale (COWS). Journal of Psychoactive Drugs, 35(2), 253-259.

Tompkins, D., A., et al (2009), Concurrent Validation of the Clinical Opiate Withdrawal Scale (COWS) and Single-Item Indices against the Clinical Institute Narcotic Assessment (CINA) Opioid Withdrawal Instrument, Drug Alcohol Depend. 2009 Nov 1; 105(1-2): 154–159.