A 24-year-old man comes to the office for treatment of opioid use disorder. The patient has a 6-year history of heroin use, which he says has cost him most of his savings. His boss has spoken to him about his erratic moods and inconsistent work performance, and he is now in danger of losing his job. The patient asks for help, saying, "I have tried so hard to do this on my own. My parents have spent a lot of money on counseling. It helps for a while, but then I go back to using. They are fed up and refuse to see me anymore. I don't want to use, but the craving is so strong." The physician refers the patient to an opioid treatment program where he is started on maintenance therapy with methadone. During the next followup appointment, he reports a marked reduction in his cravings. Which of the following properties of the administered drug is most likely responsible for the improvement in this patient's condition?

Question

A 24-year-old man comes to the office for treatment of opioid use disorder.  The patient has a 6-year history of heroin use, which he says has cost him most of his savings.  His boss has spoken to him about his erratic moods and inconsistent work performance, and he is now in danger of losing his job.  The patient asks for help, saying, "I have tried so hard to do this on my own.  My parents have spent a lot of money on counseling.  It helps for a while, but then I go back to using.  They are fed up and refuse to see me anymore.  I don't want to use, but the craving is so strong."  The physician refers the patient to an opioid treatment program where he is started on maintenance therapy with methadone.  During the next followup appointment, he reports a marked reduction in his cravings.  Which of the following properties of the administered drug is most likely responsible for the improvement in this patient's condition?

Quizplus · Accepted Answer

Opioid use disorder is a significant health concern in the United States and has high levels of morbidity and mortality. Opioids are prescribed for their analgesic properties, but they also have euphoric effects with the potential for tolerance, dependence, and abuse. Both street and prescription opioids have a high abuse potential. Treatment of addiction includes the use of alternative opioid agonists with fewer euphoric effects and less potential for acute withdrawal and craving, thereby allowing patients to function more productively on a daily basis. In the United States, the most commonly used agonists are methadone and buprenorphine. Methadone is a full mu-opioid receptor agonist used for withdrawal and maintenance treatment for opioid use disorder. It has a long half-life, which allows it to effectively suppress cravings and withdrawal symptoms; it also blocks the euphoric effects of other opioids by maintaining high tolerance levels (Choice B). Adverse effects of methadone include QT interval prolongation and respiratory depression, accounting for its lethality in overdose. (Choices C and E) Methadone, like other opioids, produces dependence, and abrupt discontinuation of methadone causes withdrawal symptoms. The symptoms of methadone withdrawal are more prolonged and less severe than those of heroin due to methadone's long half-life but are still present. (Choice D) Methadone can cause respiratory depression with the potential for lethality in overdose, especially when combined with other CNS depressants. (Choice F) Buprenorphine is a partial agonist used alone or with naloxone (an opioid antagonist) for treatment of opioid use disorder. Buprenorphine is less likely to cause respiratory depression and mortality in overdose compared with methadone. Educational objective: Methadone is a potent, long-acting opioid agonist used in the maintenance treatment of opioid use disorder. Its prolonged effects suppress withdrawal symptoms and cravings . __________ References: American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. (http://www.ncbi.nlm.nih.gov/pubmed/26406300) Non-medical prescription opioid use and prescription opioid use disorder: a review. (http://www.ncbi.nlm.nih.gov/pubmed/26339205)

A 24-Year-Old Man Comes to the Office for Treatment of Opioid