Opioid Withdrawal Severity Scale (OWSS)
For:
Immediate Release: Fentanyl • Oxycodone • Methadone • Methadose • Morphine IR • Hydromorphone IR • Dilaudid • Codeine (Tylenol #2, #3, #4)
Extended Release: Hydromorphone ER, Codeine Contin
Controlled Release: OxyContin • MS Contin • Kadian • M-Eslon
Use this checklist to classify symptoms as Mild, Moderate, or Severe. Check all that apply.
Section 1: Medication
Timeline differences (mild onset)
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Fentanyl (illicit inhaled/smoked/IV equivalent patterns): 6–12 hrs
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Hydromorphone IR (Dilaudid): 6–12 hrs
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Oxycodone IR (Percocet): 8–14 hrs
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Morphine IR: 8–12 hrs
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Codeine IR (Tylenol #2, #3, #4): 6–12 hrs
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Methadone / Methadose: 24–36 hrs
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Morphine ER (MS Contin): 12–24 hrs
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Morphine ER (Kadian, M-Eslon, SROM): 8–24 hrs
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Oxycodone ER (OxyContin): 12–24 hrs
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Hydromorphone ER (Hydromorph Contin): 12–24 hrs
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Codeine ER (Codeine Contin): 12–24 hrs​
​
If only mild symptoms checked → Mild Withdrawal.
​Timeline differences (moderate phase)
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Fentanyl (illicit inhaled/smoked/IV equivalent patterns): escalates fast; peaks quickly
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Hydromorphone IR (Dilaudid): sharp moderate phase, short duration
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Oxycodone IR (Percocet): predictable moderate phase
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Morphine IR: moderate for 2–4 days
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Codeine IR (Tylenol #2, #3, #4): moderate symptoms usually <48 hours
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Methadone / Methadose: gradual rise; longest plateau
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Morphine ER (MS Contin): slower buildup; moderate phase lasts longer
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Morphine ER (Kadian, M-Eslon, SROM): similar to MS Contin; 3–5 days
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Oxycodone ER (OxyContin): moderate for ~3–5 days, longer buildup and taper
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Hydromorphone ER (Hydromorph Contin): slow escalation, longer tail
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Codeine ER (Codeine Contin): moderate symptoms usually <48 hours
​
If 5–10 moderate symptoms checked → Moderate Withdrawal.
Timeline differences (severe phase)
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Fentanyl (illicit inhaled/smoked/IV equivalent patterns): severe phase 24–48 hrs; wave-like
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Hydromorphone IR (Dilaudid): sharp moderate phase, short duration
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Oxycodone IR (Percocet): 2–3 days
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Morphine IR: 2–4 days
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Codeine IR (Tylenol #2, #3, #4): severe withdrawal rare unless chronic high-dose
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Methadone / Methadose: 10–14+ days; heaviest withdrawal
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Morphine ER (MS Contin): 3–5 days
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Morphine ER (Kadian, M-Eslon, SROM): similar to MS Contin; 3–5 days
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Oxycodone ER (OxyContin): 3–5 days; longer crash than IR
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Hydromorphone ER (Hydromorph Contin): 1–3 days; sharp but short
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Codeine ER (Codeine Contin): severe withdrawal rare unless chronic high-dose
​
If multiple severe symptoms checked → Severe Withdrawal. Seek medical help.
Withdrawal duration
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Fentanyl (illicit inhaled/smoked/IV equivalent patterns): 5–7 days
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Hydromorphone IR (Dilaudid): 2–5 days
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Oxycodone IR (Percocet): 4–6 days
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Morphine IR: 3–5 days
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Codeine IR (Tylenol #2, #3, #4): 1–3 days
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Methadone / Methadose: 10–21 days
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Morphine ER (MS Contin): 4–7 days
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Morphine ER (Kadian, M-Eslon, SROM): 3–7 days
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Oxycodone ER (OxyContin): 6–8 days
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Hydromorphone ER (Hydromorph Contin): 4–7 days
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Codeine ER (Codeine Contin): 3–5 days​
​
​
2. Moderate Withdrawal
Physical
â–¡ Dilated pupils
â–¡ Moderate chills / sweating
â–¡ Restless legs
â–¡ Nausea
â–¡ Abdominal cramps
â–¡ Increased heart rate
â–¡ Elevated blood pressure
â–¡ Moderate muscle/bone pain
Mental
â–¡ Strong anxiety
â–¡ Difficulty concentrating
â–¡ Strong cravings
â–¡ Agitation
​
3. Severe Withdrawal
Physical
â–¡ Repeated vomiting
â–¡ Diarrhea
â–¡ Severe abdominal cramping
â–¡ Uncontrollable sweating
â–¡ Severe chills/shaking
â–¡ Tachycardia (racing heart)
â–¡ Very high blood pressure
â–¡ Severe muscle/bone pain
â–¡ Can’t keep fluids down (dehydration risk)
Mental
â–¡ Panic
â–¡ Intense agitation
â–¡ Desperation / inability to function
â–¡ Severe insomnia (>24 hours awake)
â–¡ Intrusive thoughts
Red Flags (urgent medical attention)
â–¡ Fainting or near-fainting
â–¡ Irregular heartbeat
â–¡ Confusion
â–¡ No urine for 8+ hours
â–¡ Vomiting blood or black stool
​
4. Quick Comparison Table
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5. How to Use This Scale
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Mild: supportive care, hydration, rest
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Moderate: tapering guidance or clinical supervision recommended
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Severe: safest to stabilize with OAT or seek medical support
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Red Flags: call 911 or seek urgent care
Note: If you are 20 years old or younger, even if you are legally an adult, please speak with a trusted adult — such as a school counsellor, family member, or doctor — before seeking private peer support. It’s important to have guidance from someone closer to your situation.
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