PDF Clinical Opiate Withdrawal Scale (COWS) - ASAM COWS / Flow-sheet format for measuring symptoms over a period of time . GI Upset: over last ½ hour . 0 no GI symptoms 1 stomach cramps 2 nausea or loose stool 3 vomiting or diarrhea 5 Multiple episodes of diarrhea or vomiting . Tremor . observation of outstretched hands. 0 No tremor 1 tremor can be felt, but not observed 2 slight tremor observable