Opioid withdrawal can consist of different symptoms at varying severities. Calculating an opioid withdrawal score provides insight for your doctor when it comes to customizing your treatment and recovery plan.

When your body becomes tolerant and dependent on an opioid substance, suddenly stopping or reducing how much you take can cause withdrawal.

While there are common symptoms in opioid withdrawal, your experience can vary depending on the type of opioid you take, how much you use, how frequently you use it, and individual factors like your health and metabolism.

To understand the severity of your symptoms and create an effective therapy plan, your doctor will use an opioid withdrawal scale. These assessment tools document your symptoms and how significantly they’re affecting you.

While dozens of opioid withdrawal scales are available for use in research and clinical practice, the Clinical Opiate Withdrawal Scale (COWS) is one of the most common.

The Clinical Opiate Withdrawal Scale (COWS) is an 11-item questionnaire used to assess your current withdrawal symptoms. While its name refers specifically to opiates, substances derived from natural opium, it’s also used to evaluate opioid withdrawal, which includes synthetic and semi-synthetic substances developed to mimic natural opiates.

The COWS scores across 11 symptom categories:

These are common symptoms of opioid withdrawal, but they are not the only symptoms you might experience.

Your COWS score is used as an informative tool for your overall withdrawal management. It does not definitely diagnose withdrawal — but it is a critical part of a multistep evaluation process. Your doctor will also take into account toxicology reports, laboratory results, your substance use history, and your overall health.

COWS provides a standardized way to measure withdrawal symptoms specifically relevant to treatment planning. It paints a comprehensive picture of what you’re experiencing compared with what’s expected based on clinical practice and research.

For example, scoring high in one area of COWS can inform your doctor of a need for targeted therapies while also providing an overall representation of withdrawal severity.

The severity of your symptoms can provide a clue about which stage of withdrawal you’re going through and can suggest your level of dependence on a substance.

Each category on the COWS is scored from 0 up to 4 or 5, with 0 representing the absence of a symptom and 5 indicating the highest severity of a symptom.

A score of 5 to 12 is considered a mild withdrawal. A score of 13 to 24 is a moderate withdrawal, 25 to 26 is a moderately severe withdrawal, and scoring higher than 36 suggests severe withdrawal.

However, scoring high on the COWS alone doesn’t always mean you’re experiencing intense withdrawal. For example, similar symptoms can also be seen in severe cases of the flu. For this reason, your doctor uses the COWS alongside other assessment tools and practices that confirm opioid withdrawal.

While withdrawal symptoms can be overwhelming, you can recover from opioid use, and opioid withdrawal can be successfully managed. Working with your doctor or an addiction specialist can support your physical recovery while providing therapy opportunities to learn coping strategies for long-term success.

To learn more about opioids, check out these resources from Healthline:

In severe cases, opioid withdrawal can cause serious and even life threatening symptoms. Getting professional support is the best way to manage these symptoms and access mental health therapy and other resources. To speak with someone about opioid misuse or opioid withdrawal, or to find local treatment options, you can:

The opioid withdrawal experience can be different for everyone.

To assess the stage of withdrawal you’re in, the extent of opioid dependence, and your overall symptom severity, your doctor will use an evaluation tool like the Clinical Opiate Withdrawal Scale.

Your opiate withdrawal score will be considered alongside your physical examination, toxicology reports, laboratory results, and medical history to create an individualized withdrawal management and recovery plan.