The decision of which agent to select is related to the treatment setting; opioid agonist therapy requires high levels of regulation in a supervised program. Because this patient has been discharged from his methadone program and is unwilling to enter a supervised detox setting, opioid agonists (methadone, buprenorphine) for detox would not be advised. Clonidine, an alpha 2 adrenergic agonist, would be the most appropriate choice to reduce this patient's level of autonomic arousal and discomfort. His vital sign abnormalities would be expected to normalize with treatment of his withdrawal symptoms. Common adjunctive treatment includes benzodiazepines, and antiemetics and antidiarrheals for symptomatic relief.