Resting Pulse Rate (bpm)

≤ 80 bpm+081–100 bpm+1101–120 bpm+2> 120 bpm+4

Sweating (past 30 min, not from room temp or activity)

0 — No report of chills or flushing+01 — Subjective complaint of chills or flushing+12 — Flushed or observable moistness on face+23 — Beads of sweat on brow or face+34 — Sweat streaming off face+4

Restlessness (observation during assessment)

0 — Able to sit still+01 — Reports difficulty sitting still, but is able to do so+13 — Frequent shifting or extraneous movements of legs/arms+35 — Unable to sit still for more than a few seconds+5

Pupil Size

0 — Pupils pinned or normal size for room light+01 — Pupils possibly larger than normal for room light+12 — Pupils moderately dilated+25 — Pupils so dilated only the rim of the iris is visible+5

Bone or Joint Aches (above baseline pain)

0 — Not present+01 — Mild diffuse discomfort+12 — Patient reports severe diffuse aching of joints or muscles+24 — Rubbing joints/muscles; unable to sit still because of discomfort+4

Runny Nose or Tearing (not from cold or allergies)

0 — Not present+01 — Nasal stuffiness or unusually moist eyes+12 — Nose running or tearing+24 — Nose constantly running or tears streaming down cheeks+4

GI Upset (over the last 30 minutes)

0 — No GI symptoms+01 — Stomach cramps+12 — Nausea or loose stool+23 — Vomiting or diarrhea+35 — Multiple episodes of diarrhea or vomiting+5

Tremor (observation of outstretched hands)

0 — No tremor+01 — Tremor can be felt but not observed+12 — Slight tremor observable+24 — Gross tremor or muscle twitching+4

Yawning (observation during assessment)

0 — No yawning+01 — Yawning once or twice during assessment+12 — Yawning 3 or more times during assessment+24 — Yawning several times per minute+4

Anxiety or Irritability

0 — None+01 — Patient reports increasing irritability or anxiousness+12 — Patient obviously irritable or anxious+24 — So irritable or anxious that participation is difficult+4

Gooseflesh Skin (piloerection)

0 — Skin is smooth+03 — Piloerection can be felt, or hairs standing up on arms+35 — Prominent piloerection+5

COWS: Opioid Withdrawal Scale

COWS: Opioid Withdrawal Scale