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Printed on 4/21/2026
For informational purposes only. This is not medical advice.
COWS is a structured withdrawal severity tool that combines observed and reported symptoms to classify opioid withdrawal intensity and support treatment planning in supervised settings.
Formula: COWS total = sum of 11 domain scores (range 0-48).
Higher COWS totals indicate more severe opioid withdrawal symptoms and support escalation of supervised withdrawal management intensity.
Use in monitored opioid withdrawal settings to trend symptom burden and support treatment timing and reassessment decisions.
Symptoms can overlap with anxiety, infection, stimulant effects, and other medical conditions, so the score should be interpreted within full clinical context.
For related assessments, see Opioid Risk Tool, Opioid MME and POSS Scale.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
Screen risk of opioid misuse with the Opioid Risk Tool before initiating long-term opioid therapy.
PharmacyCalculate morphine milligram equivalents (MME) for opioid medications using CDC conversion factors. ≥50 MME/day warrants caution; ≥90 MME/day carries significantly increased overdose risk.
PharmacyClassify opioid-related sedation severity (S, 1, 2, 3, 4) and map to common bedside action guidance.