For informational use only. This tool does not constitute medical advice. If you are experiencing severe withdrawal symptoms, seek medical attention immediately. The COWS scale is a clinical instrument — this self-assessment version is adapted for personal tracking purposes only.

Resting Heart Rate (RHR)

After sitting or lying down for one minute, check your pulse manually at your wrist or neck. Count beats for 15 seconds and multiply by 4. Rate only if elevated due to withdrawal, not exercise.

080 BPM or below (less than 20 beats in 15 seconds)181–100 BPM (20–25 beats in 15 seconds)2101–112 BPM (25–28 beats in 15 seconds)3113–120 BPM (28–30 beats in 15 seconds)4Greater than 120 BPM (more than 30 beats in 15 seconds)

Cold Sweats

The sensation of being simultaneously drenched in sweat and feeling intensely cold — goosebumps, clammy skin, feeling unable to get warm. Rate your experience over the past half hour, not accounted for by room temperature or physical activity.

0No chills or flushing1Some chills or slight flushing of the face2Observably flushed face or moistness on face3Beads of sweat on brow or face4Sweat streaming off of face

Restless Legs Syndrome (RLS)

An irresistible, often unpleasant urge to move the legs, typically triggered by rest and significantly relieved by movement. Can manifest as crawling, itching, pulling, or aching deep within the legs, arms, or other parts of the body.

0Able to sit still comfortably1Difficulty sitting still, but able to do so3Frequent shifting or movement of limbs5Completely unable to be still for more than a couple of seconds

Pupil Size (Mydriasis)

Pupil dilation occurs during opioid withdrawal due to disruption of the autonomic nervous system's balance — a rebound increase in sympathetic activity. Assess in normal room light.

0Pupils pinned or normal size for room light1Pupils possibly larger than normal for room light2Pupils moderately dilated5Pupils so dilated that only the rim of the iris is visible

GI Upset

Gastrointestinal distress is a hallmark of opioid withdrawal. Rate over the past half hour.

Tremor

Observe hands. Rate the severity of any tremor present.

0No tremor1Tremor can be felt but not observed2Slight tremor observable4Gross tremor or muscle twitching

Yawning

Excessive yawning is a common early sign of opioid withdrawal. Observe over the past few minutes.

0No yawning1Yawning once or twice during assessment2Yawning three or more times during assessment4Yawning several times per minute

Anxiety or Irritability

Rate your current level of anxiety or irritability as it relates to withdrawal, not pre-existing conditions.

0None1Patient reports increasing irritability or anxiousness2Patient obviously irritable or anxious4Patient so irritable or anxious that participation is difficult

Goosebumps (Piloerection)

Goosebumps or piloerection (hair standing on end) is a classic sign of opioid withdrawal, sometimes called 'cold turkey.' Observe skin, particularly on arms.

0Skin is smooth3Piloerection of skin can be felt or hairs standing up on arms5Prominent piloerection

Runny Nose or Tearing

Not accounted for by cold symptoms or allergies.

0Not present1Nasal stuffiness or unusually moist eyes2Nose running or tearing4Nose constantly running or tears streaming down cheeks

Bone or Joint Aches

Deep aching in bones or joints that is not accounted for by pre-existing conditions.

0Not present1Mild diffuse discomfort2Patient reports severe diffuse aching of joints/muscles4Patient is rubbing joints or muscles and is unable to sit still because of discomfort

Please rate all 11 symptoms to calculate your score (11 remaining)

Ready to Start Your Taper?

Use the Taper Calculator to generate a personalized day-by-day SR-17018 schedule with total dosage needed.

Taper Calculator →