COWS Opioid Withdrawal Assessment

Clinical Opiate Withdrawal Scale (COWS) inspection template to score the 11-item withdrawal assessment, document severity, and record the corresponding medication response.

Assessment Context and Patient Readiness

• Assessment date and time recorded
• Patient is awake, able to participate, and assessment conditions are appropriate
• Recent opioid use or withdrawal timing documented
  Document last reported opioid use, time since last use, or relevant withdrawal onset details.
• Baseline vital signs obtained
  Record vital signs per local protocol before or during scoring when clinically indicated.
• Safety precautions and observation level appropriate
  Confirm the patient is in a safe setting for withdrawal monitoring and medication administration.

COWS Item Scoring

• Resting pulse rate
  Enter the observed or measured pulse rate used for the COWS score.
• Sweating
  Document the observed sweating severity.
• Restlessness
  Assess observable motor restlessness.
• Pupil size
  Assess pupils in adequate lighting and document dilation severity.
• Bone or joint aches
  Document patient-reported aches and observable discomfort.
• Runny nose or tearing
  Assess autonomic signs such as lacrimation or rhinorrhea.
• Gastrointestinal upset
  Document nausea, vomiting, abdominal cramping, or diarrhea as applicable.
• Tremor
  Observe hand tremor with arms extended if needed.
• Yawning
  Document observed yawning frequency during the assessment period.
• Anxiety or irritability
  Assess subjective distress and observable irritability.
• Gooseflesh skin
  Inspect for piloerection as part of the withdrawal exam.

Total Score and Clinical Interpretation

• Total COWS score
  Enter the summed COWS score from all 11 items.
• Withdrawal severity documented
  Document the clinical interpretation of the total score using the facility's protocol.
• Medication response or treatment action documented
  Record the medication given, dose, time, and observed response, or document why medication was withheld and what follow-up was initiated.