A 29-year-old male with opioid use disorder presents to an outpatient clinic requesting buprenorphine induction. His last use of heroin was approximately 16 hours ago. On assessment using the Clinical Opiate Withdrawal Scale (COWS), he demonstrates mild rhinorrhea, goosebumps on his arms, dilated pupils (5 mm), restlessness with frequent position changes, mild GI cramping without vomiting, mild joint aches, and mild anxiety. His COWS score is 11. He reports, 'I feel terrible, I need something now.' The PMHNP is determining whether sufficient withdrawal is present to safely initiate buprenorphine. Which assessment interpretation most accurately reflects the clinical significance of this COWS score?