The COWS: What is It, and How is It Measured?

The Clinical Opiate Withdrawl Scale (COWS) is a clinician-administered analysis that determines the severity of opioid withdrawal in opioid use disorder (OUD) patients and gauges their level of dependence on the substance. 

While the test was initially developed for Buprenorphine treatment, it is now widely used in other clinical practices, including chronic pain assessment and Methadone maintenance. The COWS is a versatile assessment and may be used in an inpatient or outpatient setting, making it an effective choice for clinicians.

How Is the COWS Measured?

Designed to be used quickly in 2 minutes or less, the COWS rates 11 common symptoms of opioid withdrawal over a period of time and measures both subjective symptoms and objective signs, reducing the likelihood of inaccurate patient responses. 

The rated signs and symptoms in the COWS are: 

    1. Resting pulse rate
    2. Sweating
    3. Restlessness
    4. Pupil size
    5. Bone or joint aches
    6. Runny nose or tearing
    7. GI upset
    8. Hand tremors
    9. Yawning
    10. Anxiety or irritability 
    11. Gooseflesh skin


Each symptom is assigned a point value to its severity—0 being the least severe, 5 being the most severe. The OUD patient is then assigned a cumulative point value at the end of the assessment, placing the patient in a category of mild, moderate, moderately severe, or severe withdrawal.

Monitoring S.T. Genesis with COWS

S.T. Genesis is a brand new device that utilizes a widely known technique to make it easily accessible for medical providers. The COWS is effectively used to monitor the patient’s progress while using S.T. Genesis over the initial 120-hour period of withdrawal.

S.T. Genesis is a Percutaneous Nerve Field Stimulator (PNFS) device that provides deep neural stimulation to the brain through the cutaneous branches on the ear. The utilization of the vagus and trigeminal nerves has been shown to reduce opioid withdrawal symptoms without the risks of deep neural implants.


S.T. Genesis provides relief of opioid withdrawal symptoms through drug-free intervention. If you are interested in learning more about how S.T. Genesis can support your opioid-dependent patients long-term through a short-term solution, visit:

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