Opioid Withdrawal 549
Associated Features Supporting Diagnosis
Males with opioid withdrawal may experien ce piloerection, sweating, and spontaneous
ejaculations while awake. Opioid withdrawal is distinct from opioid use disorder and
does not necessarily occur in the presence of the drug-seeking behavior associated with
opioid use disorder. Opioid withdrawal may o ccur in any individual after cessation of re-
peated use of an opioid, whether in the se tting of medical management of pain, during
opioid agonist therapy fo r opioid use disorder, in the contex t of private recreational use, or
following attempts to self-treat sympto ms of mental disorders with opioids.
Prevalence
Among individuals from various  clinical settings, opioid withdrawal occurred in 60% of
individuals who had used heroin at least once in the prior 12 months. 
Development and Course
Opioid withdrawal is typical in the course of an opioid use disorder. It can be part of an es-
calating pattern in which an opioid is used to  reduce withdrawal symptoms, in turn lead-
ing to more withdrawal at a later time. Fo r persons with an established opioid use
disorder, withdrawal and attempts to  relieve withdrawal are typical. 
Differential Diagnosis
Other withdrawal disorders. The anxiety and restlessness associated with opioid with-
drawal resemble symptoms seen  in sedative-hypnotic withdrawal. However, opioid with-
drawal is also accompanied by rhinorrhea, la crimation, and pupillary dilation, which are
not seen in sedative-type withdrawal. 
Other substance intoxication. Dilated pupils are also seen in hallucinogen intoxication
and stimulant intoxication. However, other signs or symptoms of opioid withdrawal, such
as nausea, vomiting, diarrhea, abdominal cram ps, rhinorrhea, and lacrimation, are not