Clinical Measures

COWS - Clinical Opiate Withdrawal Scale

Description

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.
  • Because it is a provider-administered measure, when assigned it will not appear in the patient’s MYIO account. Instead, it will be queued up for you to fill out when you start your next note for that patient. Or you can add it directly to any Mobile Note using the “Add a Measure” feature.

Scores Produced

COWS Total (0-48)

Interpretation

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

References

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

Downloads

 cows_induction_flow_sheet.pdf

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