Withdrawal assessment
Clinical Opiate Withdrawal Scale (COWS)
Quantify withdrawal signs and symptoms for clinician assessment
Reference information · Questionnaire
- Last content update
- 2026-10-26
- Clinical review
- Not independently reviewed
- Source jurisdiction
- See individual sources
- Coverage
- Questionnaire
| Field | Instrument context |
|---|---|
| Version | Original English Clinical Opiate Withdrawal Scale (COWS); source-specific item anchors |
| Population | Adults in a supervised clinical assessment setting |
| Respondent | Trained clinician examination and interview |
| Recall period | Current examination; item-specific recent observation periods as stated |
| Purpose | Quantify withdrawal signs and symptoms for clinician assessment |
Assessment tool
A total does not establish individual item responses.
For each item, select the number that best describes the patient’s signs or symptom. 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 increased pulse rate would not add to the score.
CIWA-Ar: Sullivan and colleagues (1989). COWS: Wesson and Ling (2003). Preserve selected-source attribution.
Responses stay in this page’s memory. Reset or leave the page to clear them. No patient identifiers are collected.
Interpretation & limitations
- The total is the sum of all 11 items. Source bands are 5–12 mild, 13–24 moderate, 25–36 moderately severe and greater than 36 severe withdrawal.
- A total below 5 is below the published mild band; it does not establish absence of withdrawal or safety.
- Interpret observations and competing causes clinically. The program does not determine medication initiation, timing or dose.
- Use a trained clinician and the complete examination. Assess competing causes of signs and symptoms.
- Missing responses are not zero. A score does not establish diagnosis, determine medication or establish safety.
References · 2
- Exact English form, questions and response anchors
- Government public-domain statement · Alaska Department of Health and Social Services identifies CIWA-Ar and COWS as public domain. CIWA-Ar source also explicitly states it is not copyrighted and may be used freely.