Symptoms may take 2—4 days to emerge in the case of longer-acting drugs such as metha- done, LAAM (L—alpha-acetylmethadol), or buprenorphine. Acute withdrawal symptoms for a short—acting opioid such as heroin usually peak within 1—3 days and gradually subside over a period of 5—7 days. Less acute withdrawal symptoms can last for weeks to months.
These more chronic symptoms include anxiety, dysphoria, anhedonia, and insomnia.
Males with opioid withdrawal may experience 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 occur in any individual after cessation of re- peated use of an opioid, whether in the setting of medical management of pain, during opioid agonist therapy for opioid use disorder, in the context of private recreational use, or following attempts to self—treat symptoms of mental disorders with opioids.
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.
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. For persons with an established opioid use disorder, withdrawal and attempts to relieve withdrawal are typical.
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, lacrimation, 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 cramps, rhinorrhea, and lacrimation, are not present.
Other opioid-induced disorders. Opioid withdrawal is distinguished from the other opioid-induced disorders (e.g., opioid-induced depressive disorder, with onset during withdrawal) because the symptoms in these latter disorders are in excess of those usually associated with opioid withdrawal and meet full criteria for the relevant disorder.
The following opioid-induced disorders are described in other chapters of the manual with disorders with which they share phenomenology (see the substance/ medication-induced mental disorders in these chapters): opioid-induced depressive disorder (”Depressive Dis- functions”). For opioid intoxication delirium and opioid withdrawal delirium, see the crite- ria and discussion of delirium in the chapter ”Neurocognitive Disorders.” These opioid- induced disorders are diagnosed instead of opioid intoxication or opioid withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.
292.9 (F11.99)
This category applies to presentations in which symptoms characteristic of an opioid- related disorder that cause clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning predominate but do not meet the full criteria for any specific opioid-related disorder or any of the disorders in the substance-related and addictive disorders diagnostic class.
Sedative-, Hypnotic-,
Sedative, Hypnotic, or Anxiolytic Use Disorder
Sedative, Hypnotic, or Anxiolytic Intoxication
Sedative, Hypnotic, or Anxiolytic Withdrawal
Other Sedative-, Hypnotic-, or Anxiolytic-lnduced Disorders
Unspecified Sedative-, Hypnotic-, or Anxiolytic-Related Disorder