Which of the following are physical signs of opioid use disorder?

• A. Constipation, dry skin, weight gain, and elevated blood pressure.
• B. Elevated mood, increased energy, and euphoria.
• C. Restlessness, insomnia, and tachycardia during withdrawal.
• D. Constricted pupils, sweating, chills, runny nose, and needle tracks.

Answer: (D)

Opioid use disorder is suggested by a pattern of physical signs that reflect opioid exposure and withdrawal, with injection evidence being particularly telling. Constricted pupils (miosis) are a classic sign of opioid effect and are often present with opioid use. Sweating and a runny nose (rhinorrhea) are autonomic signs that commonly accompany withdrawal, signaling the body’s response when opioids are not present. The presence of needle tracks provides direct evidence of injection drug use, which is a common route for opioids. Together, these findings—miosis, autonomic symptoms, and injection marks—point most clearly to opioid use disorder.

Other options are less specific: mood elevation and euphoria can occur with several substances; restlessness, insomnia, and tachycardia are withdrawal signs that can occur with various drugs; constipation can occur with opioids but without pupillary changes and injection marks it’s not as indicative.