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Abstract
The clinical opiate withdrawal scale (COWS) is a clinician-administered, pen and paper
instrument that rates eleven common opiate withdrawal signs or symptoms. The summed
score of the eleven items can be used to assess a patient's level of opiate withdrawal
and to make inferences about their level of physical dependence on opioids. With increasing
use of opioids for treatment of pain and the availability of sublingual buprenorphine
in the United States for treatment of opioid dependence, clinical assessment of opiate
withdrawal intensity has received renewed interest. Buprenorphine, a partial opiate
agonist at the mu receptor, can precipitate opiate withdrawal in patients with a high
level of opioid dependence who are not experiencing opioid withdrawal. Since development
of the first opiate withdrawal scale in the mid-1930s, many different opioid withdrawal
scales have been used in clinical and research settings. This article reviews the
history of opiate withdrawal scales and the context of their initial use. A template
version of the COWS that can be copied and used clinically is appended. PDF formatted
versions of the COWS are also available from the websites of the American Society
of Addiction Medicine, the California Society of Addiction Medicine, the UCLA Integrated
Substance Abuse Programs, and AlcoholMD.com.
[1
] a CNS Medications Development , Oakland, California
[2
] b Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral
Sciences , David Geffen School of Medicine at University of California Los Angeles