548 Substance-Related and Addictive Disorders
6. Diarrhea.
7. Yawning.
8. Fever.
9. Insomnia.
C. The signs or symptoms in Criterion B cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
D. The signs or symptoms are not attributable to another medical condition and are not
better explained by another mental disorder, including intoxication or withdrawal from
another substance.
Coding note: The ICD-9-CM code is 292.0. The IC D-10-CM code for opioid withdrawal is
F11.23. Note that the ICD-10-CM code indicates the comorbid presence of a moderate or
severe opioid use disorder, reflecting the fact that opioid withdrawal can only occur in the
presence of a moderate or severe opioid use disorder. It is not permissible to code a co-
morbid mild opioid use disorder with opioid withdrawal.
Diagnostic Features
The essential feature of opioid withdrawal is  the presence of a characteristic withdrawal
syndrome that develops after the cessation of  (or reduction in) opioid use that has been
heavy and prolonged (Cri terion A1). The withdrawal synd rome can also be precipitated
by administration of an opioid  antagonist (e.g., naloxone or naltrexone) after a period of
opioid use (Criterion A2). This may also occur after administration of an opioid partial ag-
onist such as buprenorphine to a person  currently using a full opioid agonist.
Opioid withdrawal is characte rized by a pattern of signs and symptoms that are oppo-
site to the acute agonist effects. The first of these are subjective and consist of complaints of
anxiety, restlessness, and an “achy feeling” that is often located in the back and legs, along