What are the typical symptoms of opioid withdrawal?

Opioid withdrawal is uncomfortable but not life-threatening in healthy adults (unlike alcohol/benzodiazepine withdrawal). Symptoms: anxiety, restlessness, dysphoria; pupils dilated (mydriasis — opposite of intoxication which causes pinpoint pupils); muscle aches and bone pain; abdominal cramps, diarrhea, nausea/vomiting; runny nose (rhinorrhea), tearing (lacrimation), yawning, sneezing; sweating, chills, fever; piloerection ('goosebumps'); tachycardia, hypertension; insomnia. Duration: short-acting opioids (heroin, oxycodone, morphine) — onset 6-12 hours, peak 36-72 hours, resolves 5-7 days; long-acting (methadone) — onset 24-48 hours, peak 4-6 days, resolves 14+ days. Severity scale: COWS (Clinical Opiate Withdrawal Scale). Treatment options: (1) Medication-assisted treatment (MAT) — gold standard for opioid use disorder. Methadone: full agonist, long half-life, prevents withdrawal and cravings; only at certified clinics. Buprenorphine: partial agonist, ceiling effect on respiratory depression, available through certified providers; often combined with naloxone (Suboxone) to deter injection. Naltrexone: opioid antagonist, oral or monthly injection, requires being opioid-free before starting; (2) Symptomatic management — clonidine (reduces autonomic symptoms), antiemetics, antidiarrheals, analgesics for muscle aches, hydroxyzine for anxiety, melatonin or trazodone for sleep. While withdrawal is not life-threatening directly, complications include dehydration from vomiting/diarrhea, suicidal ideation from acute depression, return to use after detoxification is leading cause of overdose death (tolerance drops during abstinence). Pregnancy: methadone or buprenorphine — withdrawal can cause fetal distress; opioid-dependent pregnant women should NOT detox abruptly.