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Updated: January 24, 2021

What is COWS? (The Clinical Opioid Withdrawal Scale)

Addiction is not a one-size-fits all experience. Some people get clean and sober after months while others don’t find recovery for years. Everyone’s journey is different, which is why when withdrawing from drugs, different people experience different symptoms as well as different levels of those symptoms.

Opioids are highly addictive drugs. Withdrawal can be very uncomfortable, which is why outside help is usually required when a person detoxes from them entirely.

To help people who work in detox settings, the Clinical Opioid Withdrawal Scale was created to help them assess each individual’s need and make them as comfortable as possible during detox. There are 11 signs and symptoms of withdrawal included on the scale.

The withdrawal symptoms that are assessed by COWS are as follows:

  1. Resting pulse rate: Many people have high pulse rates when withdrawaing from opioids. This is monitored regularly. The resting pulse of 80 lower is given a “0” on the scale.  A resting pulse of 120 or higher is given a score of five, which means that a person is experiencing more intense symptoms.
  2. Sweating: Some people have a “cold sweat” or a feverish sweat, while some people experience nothing.
  3. Restlessness: A person may be unable to sit still, acting restless and moving their legs or knees a lot, even when sitting.
  4. Yawning: The clients may yawn a lot, even if they don’t appear tired.
  5. Tremors/trembling: Some people have the shakes while others don’t.
  6. Gastrointestinal issues: Vomiting, diarrhea, and muscle cramps are assessed.
  7. Pupils: Pupils may be dilated or appear pin-sized when exposed to light.
  8. Goosebumps: Some people get goosebumps on their flesh while in withdrawal. Although it’s not uncomfortable, it’s a telltale sign of withdrawal in opioid patients.
  9. Anxiety/irritability – Some people have mood swings that include severe anxiety or irritability.
  10. Bone/joint pain: A person may have a small amount or severe amount of this type of pain in their joints. Some people constantly change their position because of the pain.
  11.  Water eyes and nose: Some people experience watery eyes and runny nose, similar to symptoms of a cold. Some people will say they feel like they have the flu.

The Clinical Opiate Withdrawal Scale is an 11-point scale that helps people who work with addicted clients assess the level of withdrawal. Each of the above measures is graded from 0-5 on a scale, then the total is added up at the end.

These symptoms are measured in order to help plan a person’s first steps in recovery and help them feel as comfortable as possible. The scale doesn’t rate or grade how much of a substance has been used, it simply shows how uncomfortable a client is. It also helps workers in some situations decide if a clients needs medication-assisted treatment.

Getting Help for Opioid Addiction

Opioids are highly addicted, and few people can get clean and sober from them on their own. We help people with addictions reclaim their lives and understand their substance use disorder, learning to live with it one day at a time. Give yourself a chance! Call us at 1-619-363-4767 to learn more about your recovery options.

If you or a loved one is looking for an effective drug rehab in San Diego, call 619-363-4767. One of our caring members is ready to answer all of your questions.



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If Present Moments is the right fit for your current situation you will be speaking to Admissions Director Mark Gladden, who will be your guide throughout the process of arranging travel and undergoing an initial detox (if necessary). Mark has been the guide for dozens of men and women who have gotten their lives back by entering treatment at Present Moments. He has earned his reputation as being truly dedicated to the recovery of others. Mark will be the one to ‘show you the ropes’ when it comes to admitting to our facility for treatment

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