For each item, circle the number that best describes the patient’s signs of symptoms. Rate based the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient was jogging just prior to assessment, the increased pulse rate would not add to the score.

Table 31. Clinical Opiate Withdrawal Scale (COWS)611

Score: 5-12=mild; 13-24=moderate; 25-36=moderately severe; >36=severe withdrawal

The above appendix was developed to support clinical practice using a different methodology from the process utilized for the main body of the guideline. 

The clinical guidance provided in the appendix has been derived through guideline committee consensus following iterative discussions in reference to existing evidence and national and international evidence-based clinical practice guidelines. 

The content presented in the appendix is also informed by the opinion of expert reviewers, personal communication with study authors, and a review of position papers and practice bulletins issued by recognized addiction medicine professional organizations and authorities. In addition, where appropriate, Health Canada-approved drug product monographs, and previous and current guidance from the College of Physicians and Surgeons of BC (CPSBC) and Health Canada were consulted to ensure compliance with provincial and national safety regulations and standards for practice.