COWS Withdrawal Survey

2. Resting Pulse Rate (BPM)
Measure pulse rate after patient is sitting or lying down for 1 minute *This question is required.

• ≤80
• 81-100
• 101-120
• >120

3. Sweating
Sweating not accounted for by room temperature or patient activity over the last 0.5 hours *This question is required.

• No report of chills or flushing
• Subjective report of chills or flushing
• Flushed or observable moistness on face
• Beads of sweat on brow or face
• Sweat streaming off face

4. Restlessness observation during assessment *This question is required.

• Able to sit still
• Reports difficulty sitting still, but is able to do so
• Frequent shifting or extraneous movements of legs/arms
• Unable to sit still for more than a few seconds

5. Pupil size *This question is required.

• Pupils pinned or normal size for room light
• Pupils possibly larger than normal for room light
• Pupils moderately dilated
• Pupils so dilated that only the rim of the iris is visible

6. Bone or joint aches
If patient was having pain previously, only the additional component attributed to opiate withdrawal is scored *This question is required.

• Not present
• Mild diffuse discomfort
• Patient reports severe diffuse aching of joints/ muscles
• Patient is rubbing joints or muscles and is unable to sit still because of discomfort

7. Runny nose or tearing
Not accounted for by cold symptoms or allergies *This question is required.

• Not present
• Nasal stuffiness or unusually moist eyes
• Nose running or tearing
• Nose constantly running or tears streaming down cheeks

8. GI Upset
Over last 0.5 hours *This question is required.

• No GI symptoms
• Stomach Cramps
• Nausea or loose stool
• Vomiting or diarrhea
• Multiple episodes of vomiting or diarrhea

9. Tremor observation of outstretched hands *This question is required.

• No tremor
• Tremor can be felt, but not observed
• Slight tremor observable
• Gross tremor or muscle twitching

10. Yawning observation during assessment *This question is required.

• No yawning
• Yawning once or twice during assessment
• Yawning three or more times during assessment
• Yawning several times/minute

11. Anxiety or irritability *This question is required.

• None
• Patient reports increasing irritability or anxiousness
• Patient obviously irritable/anxious
• Patient so irritable or anxious that participation in the assessment is difficul

12. Gooseflesh skin *This question is required.

• Skin is smooth
• Piloerection of skin can be felt or hairs standing up on arms
• Prominent piloerection