Opioid withdrawal
292.0 Opioid Withdrawal
Refer, in addition, to the text and criteria for Substance Withdrawal (see p. 201). 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 (Criterion A1). The withdrawal syndrome can be also precipitated by administration of an opioid antagonist (e.g., naloxone or naltrexone) after a period of opioid use (Criterion A2). Opioid Withdrawal is characterized by a pattern of signs and symptoms that are opposite 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, accompanied by a wish to obtain opioids ("craving") and drug-seeking behavior, along with irritability and increased sensitivity to pain. Three or more of the following must be present to make a diagnosis of Opioid Withdrawal: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea; pupillary dilation, piloerection, or increased sweating; diarrhea; yawning; fever; and insomnia (Criterion B). Piloerection and fever are associated with more severe withdrawal and are not often seen in routine clinical practice because individuals with Opioid Dependence usually obtain substances before withdrawal becomes that far advanced. These symptoms of Opioid Withdrawal must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion C). The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (Criterion D).
In most individuals who are dependent on short-acting drugs such as heroin, withdrawal symptoms begin within 6-12 hours after the last dose. Symptoms may take 2-4 days to emerge in the case of longer-acting drugs such as methadone or LAAM (l-alpha-acetylmethadol). 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, insomnia, and drug craving. Virtually all individuals with Opioid Dependence report a physiological component, including 50% who have experienced withdrawal.
Diagnostic criteria for 292.0 Opioid Withdrawal
- Either of the following:
- cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer)
- administration of an opioid antagonist after a period of opioid use
- Three (or more) of the following, developing within minutes to several days after Criterion A:
- dysphoric mood
- nausea or vomiting
- muscle aches
- lacrimation or rhinorrhea
- pupillary dilation, piloerection, or sweating
- diarrhea
- yawning
- fever
- insomnia
- The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.