psychiatry

Subjective Opiate Withdrawal Scale (SOWS)

16-item self-rated scale measuring severity of opiate withdrawal symptoms. Score 0–64. Complements objective COWS scale. Used to monitor withdrawal in opioid detoxification.

I feel anxious*

I feel like yawning*

I am perspiring (sweating)*

My eyes are tearing*

My nose is running*

I have goosebumps*

I am shaking*

I have hot flushes*

I have cold flushes*

My bones and muscles ache*

I feel restless*

I feel nauseous*

I feel like vomiting*

My muscles twitch*

I have stomach cramps*

I feel like using now*

Score interpretation

No Withdrawal Symptoms 0

SOWS 0 — no withdrawal symptoms reported

→ Reassess if symptoms develop; the SOWS rates how the patient feels right now.

Mild Withdrawal 1–10

SOWS 1–10 — mild opioid withdrawal symptoms

→ Symptomatic relief (loperamide, ibuprofen, clonidine); continue buprenorphine or methadone if in programme; reassess in 4–6 hours

Moderate Withdrawal 11–20

SOWS 11–20 — moderate opioid withdrawal

→ Adults: clonidine 100–150 mcg for autonomic symptoms; loperamide 4 mg for diarrhoea. Children: use a children's formulary. Consider buprenorphine induction if not already on maintenance therapy; reassess 2-hourly

Severe Withdrawal 21–64

SOWS ≥21 — severe opioid withdrawal

→ Urgent addiction medicine or psychiatry review; buprenorphine or methadone dose review; symptom-controlled withdrawal protocol; IV fluids if dehydrated; safety assessment for self-harm

Interpretation bands for the SOWS. Apply clinical judgement and local guidance.

References

Handelsman L et al. Two new rating scales for opiate withdrawal. Am J Drug Alcohol Abuse. 1987;13(3):293–308.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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