Which of the following is NOT a sign or symptom of opioid withdrawal: anxiety, constipation, insomnia, or yawning?

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Constipation is NOT a Sign or Symptom of Opioid Withdrawal

Constipation is a side effect of opioid use, not a withdrawal symptom—in fact, diarrhea (the opposite) occurs during opioid withdrawal. 1, 2

Understanding Opioid Withdrawal vs. Opioid Side Effects

The key distinction here is recognizing what happens during active opioid use versus what happens when opioids are stopped or reduced:

Established Opioid Withdrawal Symptoms

When opioids are discontinued or reduced, withdrawal manifests across multiple domains 1, 2:

Gastrointestinal symptoms include:

  • Abdominal cramps 2
  • Nausea and vomiting 1, 2
  • Diarrhea (not constipation) 1, 2
  • Decreased appetite 1

Autonomic symptoms include:

  • Sweating and diaphoresis 2
  • Lacrimation (tearing) and rhinorrhea (runny nose) 2
  • Tachycardia and hypertension 1, 2
  • Fever 2
  • Piloerection (goosebumps) 2

Musculoskeletal symptoms include:

  • Myalgias and body aches 2
  • Increased muscle tone 1, 2
  • Tremors 1, 2

Psychological/behavioral symptoms include:

  • Anxiety 1, 2
  • Agitation 1, 2
  • Insomnia 1, 2
  • Dysphoria and irritability 2
  • Yawning 2

Why Constipation is NOT a Withdrawal Symptom

Constipation occurs during active opioid use, not during withdrawal. 1, 3, 4 Opioids bind to mu receptors in the colon and cause constipation as a direct pharmacologic effect, affecting up to 80% of patients taking chronic opioid therapy. 1 This is termed opioid-induced constipation (OIC) and represents opioid bowel dysfunction. 3

When opioids are withdrawn, the gastrointestinal system experiences a rebound effect with increased motility, resulting in diarrhea rather than constipation. 1, 5 This is why diarrhea is a cardinal feature of opioid withdrawal while constipation resolves. 1, 2

Clinical Assessment Tools

The validated Clinical Opiate Withdrawal Scale (COWS) specifically evaluates withdrawal symptoms including heart rate, rhinorrhea/lacrimation, gastrointestinal symptoms (diarrhea), tremor, yawning, anxiety, and piloerection—but does not include constipation. 2

Common Pitfall to Avoid

Do not confuse the side effects of opioid therapy (constipation, sedation, nausea during use) with the symptoms of opioid withdrawal (diarrhea, insomnia, anxiety when stopped). 4, 5 These represent opposite physiologic states: opioid receptor activation versus opioid receptor deprivation. 1, 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Opioid Abstinence Syndrome

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Research

Opioid complications and side effects.

Pain physician, 2008

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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