Opiate Withdrawal Scale

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The opiate withdrawal scale, also known as COWS, is a tool used by doctors and medical staff to assess what level of opiate withdrawal that someone is in. Where you fall on the opiate withdrawal scale will let the health care professional know what form of treatment to give you to make you as comfortable as possible.


Below, are the eleven things that are measured during the opiate withdrawal scale test:

  1. Resting Pulse Rate
  2. Amount of Sweat present that is not accounted for by room temperature
  3. Restlessness
  4. Pupil Size
  5. Bone or Joint Aches
  6. Runny nose or tearing
  7. GI Upset
  8. Tremors
  9. Yawning
  10. Gooseflesh


The opiate withdrawal scale is the most part necessary because everyone exhibits withdrawal symptoms differently. Most people report three distinct stages to withdrawal.

The Beginning – For many, this feels very similar to the flu. You start getting some slight body aches, have a runny nose, and just generally feel run down. For someone that has never been through opiate withdrawal before, they do in most cases not even realize that the sickness they feel has to do with the fact that their body is starting to rebel to the fact that they have not taken any opiates.

The Middle – In this stage, the actual aches, pains, and stomach upset begin for most. You are unable to keep your legs still, and they move as if they have a mind of their own. Each and every bone in your body start to hurt, much in the same way that you would feel if you just worked out for 24 hours straight. To top it all off, this is the stage when people begin to throw up, and to have upset stomachs and diarrhea. In cases where someone is making a conscious effort to kick their habit, this is generally the stage where they give up the fight, and as long as they are able to obtain their opiate of choice, will go right back to using again.

The End – This is where all of the symptoms of opiate withdrawal start running together. You can’t sleep, stop throwing up, sit still, or stop sweating. Many times people going through this stage have said they would prefer to die than to go through it. Depending on the level of addiction, this stage can last, and has lasted for up to a month for many people.

As you can see, the different stages that you go through when trying to kick the habit are very extreme. If you are getting medical help for your detox, which is highly recommended, the opiate withdrawal scale will let your health care provider know how to best treat the symptoms that you are prevalent.

The kinds of treatment available vary greatly in many cases depending on what your doctors philosophy is on treating withdrawal. Some doctors believe that you will have your best chance for success by taking certain medications that are available such as Suboxone, Subutex, or Methadone. All of these medicines attach to the receptors in your brain in a way that tricks your body into thinking that you have taken an opiate, thus staving off withdrawal. As a matter of fact, the majority of people that take these kinds of medicines feel no discomfort, and find it quite easy to not take their opiate of choice.

On the other hand though, there are some doctors that believe the best and only course of treatment is intensive counseling. Those surveyed have said that the counseling does help with the psychological symptoms that come along with opiate withdrawal, but do very little to nothing in the way of helping them with the physical symptoms that come with it.

In my personal opinion, the medicines available are a great starting point for breaking your habit, but counseling should be required to ensure that your recovery is a permanent one. The opiate withdrawal scale has been tweaked and altered over the year in a way that doctors are able to accurately pinpoint which stage of opiate withdrawal you are in. It’s important that when you are answering your doctors questions or taking the opiate withdrawal scale test on your own, that you don’t exaggerate any of your symptoms which is easy to do. Try to be as accurate and honest as possible so that you can get the best help to fit the level of withdrawal that you are in at the time.


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