The Clinical Opiate Withdrawal Scale score for opiate withdrawal (COWS score)
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Resting pulse rate, beats/minute (measured after the patient is sitting or lying for one minute)
≤ 80
81-100
101-120
> 120
Sweating (over the past 1/2 hours not accounted for by room temperature or patient activity)
No report of chills or flushing
Subjective report of chills or flushing
Flushed or observable moistness on the face
Beads of sweat on brow or face
Sweat streaming off the face
Restlessness (observation during assessment)
Able to sit still
Reports difficulty sitting still but is able to do so
Frequent shifting or extraneous movements of legs/arms
Unable to sit still for more than a few seconds
Pupil size
Pupils pinned or normal size for room light
Pupils possibly larger than normal for room light
Pupils moderately dilated
Pupils so dilated that only the rim of the iris is visible
Bone or joint aches (if patient was having pain previously, only the additional component attributed to opiate withdrawal is scored)
Not present
Mild diffuse discomfort
Patient reports severe diffuse aching of joints/muscles
Patient is rubbing joints or muscles and is unable to sit still because of discomfort
Runny nose or tearing (not accounted for by cold symptoms or allergies)
Not present
Nasal stuffiness or unusually moist eyes
Nose running or tearing
Nose constantly running or tears streaming down cheeks
GI upset (over last 1/2 hours)
No GI symptoms
Stomach cramps
Nausea or loose stool
Vomiting or diarrhea
Multiple episodes of vomiting or diarrhea
Tremor (observation of outstretched hands)
No tremor
Tremor can be felt, but not observed
Slight tremor observable
Gross tremor or muscle twitching
Yawning (observation during assessment)
No yawning
Yawning once or twice during assessment
Yawning three or more times during assessment
Yawning several times/minute
Anxiety or irritability
None
Patient reports increasing irritability or anxiousness
Patient obviously irritable/anxious
Patient so irritable or anxious that participation in the assessment is difficult
Gooseflesh skin
Skin is smooth
Piloerection of skin can be felt or hairs standing up on arms
Prominent piloerection
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