💊 COWS (Opioid Withdrawal)
UseTime buprenorphine induction and manage opioid withdrawal.
SourceWesson DR, Ling W. J Psychoactive Drugs 2003
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Objective withdrawal (often COWS ≥ 8–12) should precede buprenorphine.
When to use
Time buprenorphine induction and manage opioid withdrawal.
How it works
Eleven items summed: 5–12 mild, 13–24 moderate, 25–36 moderately severe, > 36 severe.
Key points
- Objective withdrawal (often COWS ≥ 8–12) should precede buprenorphine.
- Premature dosing risks precipitated withdrawal.
- Reassess frequently during induction.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Resting pulse rate | 81–100 (1) |
|---|---|
| Sweating | Beads on brow (2) |
| Restlessness | Fidgety (1) |
| Pupil size | Possibly larger (1) |
| Bone/joint aches | Mild (1) |
| Runny nose/tearing | Stuffiness (1) |
| GI upset | Nausea/loose stool (2) |
| Tremor | Felt, not seen (1) |
| Yawning | 1–2× (1) |
| Anxiety/irritability | Mild (1) |
| Gooseflesh skin | Piloerection palpable (3) |
→COWS15
- Severity：Moderate
- Buprenorphine induction：Generally start once COWS ≥ 8–12 (objective signs present) to avoid precipitated withdrawal.
| Resting pulse rate | ≤ 80 (0) |
|---|---|
| Sweating | None (0) |
| Restlessness | None (0) |
| Pupil size | Normal (0) |
| Bone/joint aches | None (0) |
| Runny nose/tearing | None (0) |
| GI upset | None (0) |
| Tremor | None (0) |
| Yawning | None (0) |
| Anxiety/irritability | None (0) |
| Gooseflesh skin | Smooth (0) |
→COWS0
- Severity：Minimal
- Buprenorphine induction：Generally start once COWS ≥ 8–12 (objective signs present) to avoid precipitated withdrawal.
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using COWS (Opioid Withdrawal)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does COWS (Opioid Withdrawal) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is COWS (Opioid Withdrawal) calculated in practice? Can you show a worked example?
- Inputs: Resting pulse rate 81–100 (1), Sweating Beads on brow (2), Restlessness Fidgety (1), Pupil size Possibly larger (1), Bone/joint aches Mild (1), Runny nose/tearing Stuffiness (1), GI upset Nausea/loose stool (2), Tremor Felt, not seen (1)… → Result: COWS 15（Severity: Moderate, Buprenorphine induction: Generally start once COWS ≥ 8–12 (objective signs present) to avoid precipitated withdrawal.） Inputs: Resting pulse rate ≤ 80 (0), Sweating None (0), Restlessness None (0), Pupil size Normal (0), Bone/joint aches None (0), Runny nose/tearing None (0), GI upset None (0), Tremor None (0)… → Result: COWS 0（Severity: Minimal, Buprenorphine induction: Generally start once COWS ≥ 8–12 (objective signs present) to avoid precipitated withdrawal.）