with irritability and increased sensitivity to pain. Three or more of the following must be
present to make a diagnosis of opioid with drawal: dysphoric mood; nausea or vomiting;
muscle aches; lacrimation or rhinorrhea; pu pillary dilation, piloerection, or increased
sweating; diarrhea; yawning; fever; and insomn ia (Criterion B). Piloerection and fever are
associated with more severe withdrawal and are not often seen in routine clinical practice
because individuals with opioid use disorder  usually obtain substances before with-
drawal becomes that far advanced. These sy mptoms of opioid withdrawal must cause
clinically significant distress or impairment in social, occupational, or other important ar-
eas of functioning (Criterion C). The symptoms  must not be attributable to another med-
ical condition and are not better explained by another mental diso rder (Criterion D).
Meeting diagnostic criteria for opioid withdr awal alone is not sufficient for a diagnosis of
opioid use disorder, but concurrent symptoms of craving and drug-seeking behavior are
suggestive of comorbid opioid use disorder. ICD-10-CM codes only allow a diagnosis of
opioid withdrawal in the presence of comorb id moderate to severe opioid use disorder.
The speed and severity of withdrawal associat ed with opioids depend on the half-life of
the opioid used. Most individuals who are physiologically dependent on short-acting drugs
such as heroin begin to have withdrawal symptoms within 6–12 hours after the last dose.
Symptoms may take 2–4 days to emerge in th e case of longer-acting drugs such as metha-
done, LAAM ( L-alpha-acetylmethadol), or buprenorph ine. Acute withdrawal symptoms for