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Buprenorphine
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Methadone
Morphine
Naloxone
Naltrexone
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The patient was started on a daily maintenance treatment for opioid use disorder that reduces withdrawal symptoms and cravings but carries a risk of overdose if misused and causes side effects of constipation and drowsiness, suggestive of methadone. Methadone is a long-acting, full mu-opioid agonist that binds to these receptors to prevent withdrawal symptoms and reduce opioid cravings. Since it is a full agonist, it carries a risk of opioid overdose, which would present with central nervous system depression, respiratory depression, and miosis. It can cause side effects that are typical with opioid use, including constipation and drowsiness. Patients usually never overcome the side-effect of constipation even with chronic opioid use. Because it is long-acting, it has a slow onset and long half-life thus reducing cravings for long periods of time. Methadone treatment should be carefully monitored through a methadone clinic in order to ensure compliance and avoid relapse. Mattick et al. review the efficacy of methadone maintenance treatment for opioid dependence. They find that methadone is more effective than non-pharmacologic treatment in retaining patients in treatment and suppressing opioid use. They recommend use of this medication in the treatment of opioid use disorder. Incorrect Answers: Answer 1: Buprenorphine is a partial mu-opioid agonist that is also used in the maintenance treatment of opioid use disorder to reduce withdrawal symptoms and cravings. It can also cause constipation and drowsiness as side effects due to its action on the opioid receptor but has a low risk of overdose because its effect on the opioid receptor is clamped (partial agonism). This ceiling effect helps prevent overdose. Answer 3: Morphine is also a full mu-opioid agonist but is not used to treat opioid use disorder. Morphine is used in the palliative care setting and for pain control in acute pain episodes such as surgery and in cancer patients. It should not be used chronically in ambulatory patients. Answer 4: Naloxone is an opioid antagonist. It is used in the treatment of opioid overdose, not in maintenance treatment for opioid use disorder. It rapidly reverses the effects of opioid overdose and can be life-saving. It does not prevent cravings and can cause withdrawal in patients who use opioid medications chronically. Answer 5: Naltrexone is an opioid antagonist that can be used to prevent relapse in opioid use disorder. However, it does not cause opioid-related side effects such as central nervous system depression or constipation because it is an antagonist. In addition, because it is an opioid antagonist, it cannot be abused to cause euphoria. Bullet Summary: Methadone is a full mu-opioid receptor agonist that is used in the maintenance treatment of opioid use disorder.
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