COWS (Clinical Opiate Withdrawal Scale) Calculator

x402

COWS (Clinical Opiate Withdrawal Scale) Calculator is a paid API for AI agents from api.magentlab.com, paid per call via x402, $0.005/call, status unknown (last checked 2026-09-14).

Computes the Wesson 2003 Clinical Opiate Withdrawal Scale (COWS) total score and severity category from 11 caller-assigned symptom subscores

Price / call$0.005

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How this service works

Wesson 2003 Clinical Opiate Withdrawal Scale (COWS). Eleven caller-assigned appendix integers (pulse 0/1/2/4, GI 0/1/2/3/5, sweating 0-4, tremor 0/1/2/4, restlessness 0/1/3/5, yawning 0/1/2/4, pupils 0/1/2/5, anxiety 0/1/2/4, aches 0/1/2/4, gooseflesh 0/3/5, rhinorrhea/tearing 0/1/4). Max 48. Severity 5-12 mild, 13-24 moderate, 25-36 moderately severe, >36 severe; 0-4 below mild (none). magent does not observe the patient. Not a buprenorphine induction protocol.

Output

Returns the COWS total score (sum of the 11 subscores, maximum 48) and a severity classification: 0–4 = none/below mild, 5–12 = mild, 13–24 = moderate, 25–36 = moderately severe, >36 = severe. Does not include clinical recommendations or buprenorphine induction guidance.

Example use cases

Triage opioid withdrawal severity in ED

“I'm assessing a patient in the emergency department: pulse rate scores 2, GI upset 2, sweating 3, tremor 2, restlessness 3, yawning 2, pupils 2, anxiety 2, bone aches 2, gooseflesh 0, runny nose 1 — can you calculate their COWS score and tell me how severe the withdrawal is?”

Document withdrawal level before medication decision

“Before we consider next steps, I need a COWS score: resting pulse 1, GI upset 0, sweating 1, tremor 0, restlessness 1, yawning 1, pupil size 1, anxiety 1, bone aches 1, gooseflesh 0, tearing 0 — what's the total and severity band?”

Track withdrawal progress across serial assessments

“Compare this current COWS assessment: pulse 4, GI upset 3, sweating 4, tremor 4, restlessness 5, yawning 4, pupils 5, anxiety 4, bone aches 4, gooseflesh 5, runny nose 4 — what's the score and how severe is this withdrawal?”

Technical details

Endpoint

GEThttps://api.magentlab.com/api/calc/cows

When to prefer

Use this endpoint when you need a standardized, reproducible COWS total score and severity band computed from caller-observed symptom subscores according to the Wesson 2003 scale. Prefer this over manual summation to avoid arithmetic errors and to obtain a validated severity classification. Not suitable as a replacement for clinical judgment, direct patient observation, or buprenorphine induction protocols.

Side effects

Missing any of the 11 required query parameters returns an error
Submitting out-of-range values (e.g. tremor=3 which is not valid) may return a validation error or unexpected result
Network or payment (x402) failure results in no score returned
All-zero inputs return a score of 0 with no-withdrawal classification

Input

Schema · Request body

Field	Type	Description
inputrequired	object
output	object

Output

Schema · Response

{
  "type": "json",
  "example": {
    "path": "/api/calc/cows",
    "count": 2,
    "items": [
      {
        "score": 0,
        "formula": "cows",
        "citation": {
          "id": "wesson-2003",
          "doi": "10.1080/02791072.2003.10400007",
          "pmid": "12924748",
          "title": "The Clinical Opiate Withdrawal Scale (COWS)",
          "source": "J Psychoactive Drugs. 2003;35(2):253-259",
          "authors": "Wesson DR, Ling W"
        },
        "severity": "none",
        "max_score": 48,
        "components": [
          {
            "value": 0,
            "factor": "resting_pulse_rate",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "gi_upset",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "sweating",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "tremor",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "restlessness",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "yawning",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "pupil_size",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "anxiety_or_irritability",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "bone_or_joint_aches",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "gooseflesh_skin",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "runny_nose_or_tearing",
            "points": 0,
            "present": true
          }
        ],
        "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
        "formula_expression": "COWS = resting_pulse_rate + gi_upset + sweating + tremor + restlessness + yawning + pupil_size + anxiety_or_irritability + bone_or_joint_aches + gooseflesh_skin + runny_nose_or_tearing; Wesson 2003 appendix integers only; max 48"
      },
      {
        "score": 0,
        "formula": "cows",
        "citation": {
          "id": "wesson-2003",
          "doi": "10.1080/02791072.2003.10400007",
          "pmid": "12924748",
          "title": "The Clinical Opiate Withdrawal Scale (COWS)",
          "source": "J Psychoactive Drugs. 2003;35(2):253-259",
          "authors": "Wesson DR, Ling W"
        },
        "severity": "none",
        "max_score": 48,
        "components": [
          {
            "value": 0,
            "factor": "resting_pulse_rate",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "gi_upset",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "sweating",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "tremor",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "restlessness",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "yawning",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "pupil_size",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "anxiety_or_irritability",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "bone_or_joint_aches",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "gooseflesh_skin",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "runny_nose_or_tearing",
            "points": 0,
            "present": true
          }
        ],
        "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
        "formula_expression": "COWS = resting_pulse_rate + gi_upset + sweating + tremor + restlessness + yawning + pupil_size + anxiety_or_irritability + bone_or_joint_aches + gooseflesh_skin + runny_nose_or_tearing; Wesson 2003 appendix integers only; max 48"
      }
    ]
  }
}

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How this service works

Output

Example use cases

Triage opioid withdrawal severity in ED

Document withdrawal level before medication decision

Track withdrawal progress across serial assessments

Technical details

Endpoint

GEThttps://api.magentlab.com/api/calc/cows

When to prefer

Side effects

Missing any of the 11 required query parameters returns an error
Submitting out-of-range values (e.g. tremor=3 which is not valid) may return a validation error or unexpected result
Network or payment (x402) failure results in no score returned
All-zero inputs return a score of 0 with no-withdrawal classification

Input

Schema · Request body

Field	Type	Description
inputrequired	object
output	object

Output

Schema · Response

{
  "type": "json",
  "example": {
    "path": "/api/calc/cows",
    "count": 2,
    "items": [
      {
        "score": 0,
        "formula": "cows",
        "citation": {
          "id": "wesson-2003",
          "doi": "10.1080/02791072.2003.10400007",
          "pmid": "12924748",
          "title": "The Clinical Opiate Withdrawal Scale (COWS)",
          "source": "J Psychoactive Drugs. 2003;35(2):253-259",
          "authors": "Wesson DR, Ling W"
        },
        "severity": "none",
        "max_score": 48,
        "components": [
          {
            "value": 0,
            "factor": "resting_pulse_rate",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "gi_upset",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "sweating",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "tremor",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "restlessness",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "yawning",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "pupil_size",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "anxiety_or_irritability",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "bone_or_joint_aches",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "gooseflesh_skin",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "runny_nose_or_tearing",
            "points": 0,
            "present": true
          }
        ],
        "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
        "formula_expression": "COWS = resting_pulse_rate + gi_upset + sweating + tremor + restlessness + yawning + pupil_size + anxiety_or_irritability + bone_or_joint_aches + gooseflesh_skin + runny_nose_or_tearing; Wesson 2003 appendix integers only; max 48"
      },
      {
        "score": 0,
        "formula": "cows",
        "citation": {
          "id": "wesson-2003",
          "doi": "10.1080/02791072.2003.10400007",
          "pmid": "12924748",
          "title": "The Clinical Opiate Withdrawal Scale (COWS)",
          "source": "J Psychoactive Drugs. 2003;35(2):253-259",
          "authors": "Wesson DR, Ling W"
        },
        "severity": "none",
        "max_score": 48,
        "components": [
          {
            "value": 0,
            "factor": "resting_pulse_rate",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "gi_upset",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "sweating",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "tremor",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "restlessness",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "yawning",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "pupil_size",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "anxiety_or_irritability",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "bone_or_joint_aches",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "gooseflesh_skin",
            "points": 0,
            "present": true
          },
          {
            "value": 0,
            "factor": "runny_nose_or_tearing",
            "points": 0,
            "present": true
          }
        ],
        "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
        "formula_expression": "COWS = resting_pulse_rate + gi_upset + sweating + tremor + restlessness + yawning + pupil_size + anxiety_or_irritability + bone_or_joint_aches + gooseflesh_skin + runny_nose_or_tearing; Wesson 2003 appendix integers only; max 48"
      }
    ]
  }
}