A 35-year-old male presents to the emergency department complaining of severe muscle aches, abdominal cramps, diarrhea, rhinorrhea, and piloerection. He admits to recently stopping 'pain pills' abruptly. Which of the following is the most likely diagnosis?

Explanation

The constellation of symptoms including severe muscle aches (myalgia), abdominal cramps, diarrhea, rhinorrhea (runny nose), and piloerection (goosebumps) are classic signs of opioid withdrawal. Opioid withdrawal symptoms are often described as a severe flu-like illness. Acute gastroenteritis would typically not include piloerection or rhinorrhea. Stimulant withdrawal is characterized by dysphoria, fatigue, hypersomnia, and increased appetite. Benzodiazepine withdrawal can cause anxiety, seizures, and delirium, but not typically the specific autonomic symptoms seen here.