cows_opiate_withdrawal: Clinical Opiate Withdrawal Scale (COWS)

In cliot: Clinical Indices and Outcomes Tools

Clinical Opiate Withdrawal Scale (COWS)

Description

Calculates the COWS score, an 11-item clinician-administered scale used to assess the severity of opiate withdrawal and monitor the response to treatment (e.g., buprenorphine induction). The score determines the level of physical dependence and withdrawal severity.

Usage

cows_opiate_withdrawal(pulse_score, sweating_score, restlessness_score,
                       pupil_size_score, bone_joint_ache_score,
                       runny_nose_tearing_score, gi_upset_score, tremor_score,
                       yawning_score, anxiety_irritability_score, gooseflesh_score)

Arguments

pulse_score	Numeric. Score for Resting Pulse Rate. (0: <80, 1: 81-100, 2: 101-120, 4: >120).
sweating_score	Numeric. Score for Sweating. (0: None, 1: Subjective chills/flushing, 2: Flushed/moist face, 3: Beads of sweat, 4: Drenching sweat).
restlessness_score	Numeric. Score for Restlessness. (0: Able to sit still, 1: Difficulty sitting still, 3: Moving legs/arms often, 5: Unable to sit still).
pupil_size_score	Numeric. Score for Pupil Size. (0: Normal/Constricted, 1: Normal/Slightly large, 2: Moderate dilation, 5: Severe dilation).
bone_joint_ache_score	Numeric. Score for Bone/Joint Aches. (0: None, 1: Mild diffuse discomfort, 2: Severe aches/rubbing joints, 4: Rubbing joints/unable to sit still due to pain).
runny_nose_tearing_score	Numeric. Score for Runny Nose/Tearing. (0: None, 1: Stuffy nose/moist eyes, 2: Dripping nose/tearing, 4: Constant running/streaming).
gi_upset_score	Numeric. Score for GI Upset. (0: None, 1: Cramps, 2: Nausea/loose stool, 3: Vomiting/Diarrhea, 5: Multiple vomiting/diarrhea).
tremor_score	Numeric. Score for Tremor. (0: None, 1: Not visible/can be felt, 2: Visible/mild, 4: Gross/muscle twitching).
yawning_score	Numeric. Score for Yawning. (0: None, 1: 1-2 times, 2: Several times, 4: Frequent/several per minute).
anxiety_irritability_score	Numeric. Score for Anxiety/Irritability. (0: None, 1: Increasing irritability, 2: Obviously irritable/anxious, 4: Severe anxiety/mania).
gooseflesh_score	Numeric. Score for Gooseflesh skin. (0: None, 3: Pilnoerection perceptible to touch, 5: Prominent piloerection).

Value

A list containing:

COWS_Score	The calculated total score (Range 0-48).
Severity_Category	Interpretation: Mild (5-12), Moderate (13-24), Moderately Severe (25-36), Severe (>36).

References

Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35(2):253-259. doi:10.1080/02791072.2003.10400007

Examples

# Example 1: Moderate Withdrawal
# Pulse 105 (+2), Sweating (+2), Restless (+1), Aches (+1), GI (+2), Anxiety (+2), Others 0
# Total = 10 (Wait, sum is 10, which is Mild. Let's add Tremor +2, Yawning +1 -> Total 13)
cows_opiate_withdrawal(2, 2, 1, 0, 1, 0, 2, 2, 1, 2, 0)

# Example 2: Severe Withdrawal
# Pulse >120 (+4), Drenching Sweat (+4), Severe Restlessness (+5),
# Dilated Pupils (+5), Severe Aches (+4), Vomiting (+5), Tremor (+4),
# Frequent Yawning (+4), Severe Anxiety (+4), Gooseflesh (+5), Runny Nose (+4)
# Total = 48
cows_opiate_withdrawal(4, 4, 5, 5, 4, 4, 5, 4, 4, 4, 5)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.