COWS Calculator
Score all eleven Clinical Opiate Withdrawal Scale items to grade opioid withdrawal.
Score
— / 48
Higher = more severe
11 items remaining
Scoring notes
Score only what is attributable to withdrawal— pre-existing joint pain, a head cold, or a warm room shouldn’t inflate the aches, rhinorrhea, or sweating items. Take the pulse after a full minute of rest.
Timing follows the opioid: short-acting opioids produce withdrawal within 8–24 hours of the last use; methadone may take up to 2–4 days. Serial scores tell the story a single number can’t.
Educational use only. COWS scoring supports assessment within a provider-ordered protocol; treatment decisions — including buprenorphine induction thresholds — follow facility policy and provider orders. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.