COWS

Q: All of the following are included in the Clinical Opioid Withdrawal Scale (COWS) EXCEPT?

A) Resting pulse rate

B) GI upset

C) Sweating

D) Yawning

E) Craving for abused substance

Answer: E

Clinical Opioid Withdrawal Scale (COWS) is mostly based on physical signs of withdrawal. History plays an imminent role, but the craving for abused substances is not included in COWS. Scale counts the following signs:

• Resting pulse rate
• GI upset'
• Sweating
• Tremor
• Restlessness
• Yawning
• Pupil size
• Anxiety or irritability
• Bone or joint aches
• Gooseflesh skin
• Runny nose or tearing

Score: 

- 5 to 12 = mild

- 13 to 24 = moderate

- 25 to 36 = moderately severe

- more than 36 = severe withdrawal

Scale is available free via any search engine or online medical calculators.

Reference:

Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs 2003; 35:253.