COWS (Clinical Opiate Withdrawal Scale)
The next time you have a patient in opioid withdrawal, you can use the Clinical Opiate Withdrawal Score (COWS) tool to quantify the level of severity. If the patient has a COWS of ≥8 with an objective sign of withdrawal, give 8 mg of sublingual buprenorphine - Mac Chamberlin MD
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Tiny Tips: The COWS Scale
If you are at the bedside without the COWS scale (or if you’re cramming knowledge for an exam), here is an easy mnemonic to remember the components of the scale: “STOP TRYING Joints” - S – Sweating, T – Tremor, O – pupil size (O looks like a pupil), P – Piloerection, T – Tachycardia, R – Restlessness, Y – Yawning, I – Irritability or anxiety, N – Nose running or eyes tearing, G – GI upset (vomiting / diarrhea), Joints – joint pain or bone pain. In addition to opiate agonist treatment, don’t forget other adjuncts for opiate withdrawal (including clonidine and loperamide).
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COWS Score for Opioid Withdrawal
The Clinical Opiate Withdrawal Score is a well validated tool to help determine if a patient is in opiate withdrawal.
Articles of Interest
Clinical Opiate Withdrawal Scale (COWS)
The Clinical Opiate Withdrawal Scale (COWS) is an 11-item scale designed to be administered by a clinician. This tool can be used in both inpatient and outpatient settings to reproducibly rate common signs and symptoms of opiate withdrawal and monitor these symptoms over time.
What Is the Clinical Opiate Withdrawal Scale?
A major benefit of using the COWS scale is that it can help prevent precipitated withdrawal in patients undergoing treatments involving buprenorphine (Subutex®).
Resources
MDCalc
Quantifies severity of opiate withdrawal.
