On the Clinical Opiate Withdrawal Scale (COWS), which score range indicates Moderate withdrawal?

• A. 5-12 (Mild)
• B. 13-24 (Moderate)
• C. 25-36 (Severe)
• D. 37-50 (Very Severe)

Answer: (B)

Understanding how the Clinical Opiate Withdrawal Scale (COWS) works is key: it sums up several withdrawal symptoms to yield a total score, and the higher the score, the more severe the withdrawal. The mid-range total, 13 to 24, is labeled as Moderate withdrawal because it means multiple prominent symptoms are clearly present and bothersome, but they are not yet at the level of severe or life‑distressing signs. In this range you’d typically see noticeable clues like yawning, sweating, restlessness, dilated pupils, runny nose or tearing, GI upset, tremor, and muscle aches—enough to be uncomfortable and impair functioning, but not overwhelming or dangerous.

Lower scores (around 5–12) reflect mild withdrawal with fewer symptoms, while higher scores (25–36 and above) reflect more severe to very severe withdrawal with more intense symptoms and greater distress. So the score range of 13–24 is the best fit for Moderate withdrawal.