Question 2: How is opioid withdrawal assessed?

Answer: Opioid withdrawal results from opioid abstinence in patients who are physically dependent on opioids. Assessment of opioid withdrawal can be useful in making the diagnosis of physical dependence and in making decisions regarding initiation and/or titration of medications. A number of scales have been developed for the assessment of opioid withdrawal.

These include the Objective Opioid Withdrawal Scale (OOWS), the Subjective Opioid Withdrawal Scale (SOWS) (Handelsman, Cochrane, Aronson, et al., 1987), the Short Opioid Withdrawal Scale (SOWS) (Gossop, 1990), and the Clinical Opioid Withdrawal Scale (COWS) (Wesson and Ling, 2003).

The OOWS and SOWS (Handelsman et al., 1987) are available at: (39KB).

The COWS is available at: (39KB).


Gossop M. The development of a Short Opiate Withdrawal Scale (SOWS). Addictive Behaviors 1990;15(5):487-90.

Handelsman L, Cochrane KJ, Aronson M, Ness R, Rubinstein KJ, Kanof, PD. Two new rating scales for opiate withdrawal. American Journal of Drug and Alcohol Abuse 1987;13:293-308.

Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). Journal of Psychoactive Drugs 2003;35(2):253-59.