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. Author manuscript; available in PMC: 2016 Jan 31.
Published in final edited form as: Addict Behav. 2014 Sep 28;41:20–28. doi: 10.1016/j.addbeh.2014.09.021

Table 1. Opiate Craving Scale (OCS) and Clinical Opiate Withdrawal Scale (COWS) Items and Responses.

Question Stem Response Options
OCS (Possible Range: 0 – 30)
How much do you currently crave opiates? Range: 0-10
0 = Not at all
10 = Extremely
In the past week, please rate how strong your desire to use opiates has been when something in the environment has reminded you of opiates (example: seeing a medication bottle, using the Internet, visiting a doctor's office, going to a place where you used to buy drugs)? Range 0-10
0 = Not at all
10 = Extremely
Please imagine yourself in the environment in which you previously used opiates (examples: a party, a hangout, a particular room where you live). If you were in this environment today and if it were the time of day that you typically used opiates, what is the likelihood that you would use opiates today? Range: 0 – 10
0 = Not at all
10 = Extremely
COWS (Possible Range: 0- 46)*
Resting pulse rate: measured after participant is sitting or lying for one minute 0 = Pulse rate 80 or below
1 = Pulse rate 81-100
2 = Pulse rate 101-120
4 = Pulse rate higher than 120
GI upset: over the last 1/2 hour 0 = No GI symptoms
1 = Stomach cramps
2 = Nausea or loose stool
3 = Vomiting or diarrhea
5 = Multiple episodes of diarrhea or vomiting
Sweating: over the past 1/2 hour not accounted for by room temperature or participant activity 0 = No report of chills or flushing
1 = Subjective report of chills or flushing
2 = Flushed or observable moisture on face
3 = Beads of sweat on brow or face
4 = Sweat streaming off face
Tremor: observation of outstretched hands 0 = No tremor
1 = Tremor can be felt, but not observed
2 = Slight tremor observable
4 = Gross tremor or muscle twitching
Restlessness: observation during assessment 0 = Able to sit still
1 = Reports difficulty sitting still, but is able to do so
2 = Frequently shifting or extraneous movements of legs/arms
3 = Unable to sit still for more than a few seconds
Yawning: observation during assessment 0 = No yawning
1 = Yawning once or twice during assessment
2 = Yawning three or more times during assessment
4 = Yawning several times/minute
Pupil size 0 = Pupils pinned or normal size for room light
1 = Pupils possibly larger than normal for room light
2 = Pupils moderately dilated
5 = Pupils so dilated that only the rim of the iris is visible
Anxiety or irritability 0 = None
1 = Participant reports increasing irritability or anxiousness
2 = Participant obviously irritable or anxious
4 = Participant is so irritable or anxious that participation in the assessment is difficult
Bone or joint aches: If participant was having pain previously, only the additional component attributed to opiate withdrawal is scored 0 = Not present
1 = Mild diffuse discomfort
2 = Participant reports severe diffuse aching of joints/muscles
4 = Participant is rubbing joints or muscles and is unable to sit still because of discomfort
Gooseflesh skin 0 = Skin is smooth
3 = Pilocerection of skin can be felt or hairs standing up on arms
5 = Prominent pilocerection
Runny nose or tearing: not accounted for by cold symptoms or allergies 0 = Not present
1 = Nasal stuffiness or unusually moist eyes
2 = Nose running or tearing
4 = Nose constantly running or tears streaming down cheeks

Note. The COWS is clinician-administered and based on participants’ current signs and symptoms of opiate withdrawal.

*

Due to a slight change in scoring from the original measure, the total possible score on this measure in the POATS trial was 46 instead of 48, per Tompkins et al (2009).