Flow-sheet for measuring symptoms for opiate withdrawals over a period of time 2025

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Short-acting opioids (e.g. ): Onset of opioid withdrawal symptoms 8-24 hours after last use; duration 4-10 days. Long-acting opioids (e.g. methadone): Onset of opioid withdrawal symptoms 12-48 hours after last use; duration 10-20 days.
COWS scores can range from 0 to 48. The higher the score, the more severe the opioid withdrawal youre undergoing. Scores below 5 indicate no active withdrawal. If your COWS score is higher than 36, your opioid withdrawal is considered severe.
The Clinical Institute Narcotic Assessment (CINA) Scale measures 11 signs and symptoms commonly seen in patients during narcotic withdrawal. This can help to gauge the severity of the symptoms and to monitor changes in the clinical status over time. Minimum score = 0, Maximum score = 31.
Short Opioid Withdrawal Scale7 ScoreSuggested withdrawal management 0-10 Mild withdrawal; symptomatic medication only 10-20 Moderate withdrawal; symptomatic or opioid medication 20-30 Severe withdrawal; opioid medication
Score: 5-12 = mild; 13-24 = moderate; 25-36 = moderately severe; more than 36 = severe withdrawal.
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The SOWS is a patient-completed instrument that is used to rate the intensity and presence of withdrawal symptoms. It is comprised of 16 items that reflect common symptoms associated with withdrawal; namely psychic, musculoskeletal, gastrointestinal, motor, and autonomic issues.
With most drugs, withdrawal symptoms are the most intense a day or so after a person stops using. However, extended-release drugs and long-acting opioids may have a later peak, at around 3072 hours after a person stops using them.

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