The Clinical Opiate Withdrawal Scale (COWS) and Detox

COWS is an assessment tool used in treatment and clinical settings to help decide if a client who uses opioids needs medication-assisted withdrawal or treatment. This scale is used to determine whether to utilize drugs such as methadone or buprenorphine as part of a treatment plan.

People who are experiencing severe withdrawal can benefit from the use of medications to prevent them from suffering for weeks or months after they get clean and sober.

Why Medication-Assisted Treatment?

Medications like buprenorphine can help a person who is physically dependent on the drug from feeling intense withdrawal symptoms and opioid cravings once they are clean. Medication-assisted treatment helps a person focus on self-healing and new coping skills, therapy, and other aspects of recovery rather than intense cravings and physical discomfort. This is how COWS can help treatment providers to do the best job possible.

How COWS Works

COWS is a graded scale that is used by clinicians to tailor opioid withdrawal treatment o individual needs. Both inpatient and outpatient treatment centers have used it to monitor the severity of opiate withdrawal and detox symptoms. In detox settings, it is used to make a client feel as comfortable as possible.

Some clinicians use the scale to decide how to taper somebody off of prescription medications. It ranks a person’s discomfort and medical symptoms based on 11 withdrawal symptoms, including:

  1. Resting pulse rate (and if it is unsafely high).
  2. Anxiety/irritability level
  3. Bone or joint aching
  4. A runny nose and watering eyes, like a person with a cold or allergy.
  5. Gastrointestinal symptoms such as stomach cramps, nausea or diarrhea
  6. Sweating, chills, or flushing, similar to a flu experience.
  7. Tremors or muscle twitches.
  8. Restlessness/nervousness, fidgeting, etc.
  9. A runny nose and watering eyes, like a person with a cold or allergy,
  10. Yawning/Extreme sleepiness
  11. Pupil size (dilated?)
  12. Goosebumps.


People who are detoxing are usually assigned a number for each of these eleven values, and then those numbers are added up to create an overall score. This score can help people who are treating you create a personal treatment plan and assess things like your need for medication-assisted treatment.

COWS is vital to people who work in addiction recovery settings because it helps professionals understand a clients’ needs, allowing treatment providers to create a personalized treatment plan to help clients work toward sobriety. While detox is just one part of overcoming your substance use disorder, managing it properly will help addicted persons focus on themselves and their goals, rather than merely symptoms.

Getting Help

Detoxing in a safe and therapeutic setting is the first step to recovery from addiction. Learn more about how to detox in a safe, caring environment as the first step in your recovery. Contact us confidentially at 1-877-228-2401.



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