Opioid analgesics
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Opioid use disorder, opioid dependence and withdrawal symptoms: case report A 22-year-old woman developed opioid dependence, opioid use disorder and withdrawal symptoms following treatment with fentanyl and unspecified opioid analgesics for hereditary coproporphyria (HCP). She also developed withdrawal symptoms following treatment with buprenorphine/naloxone for HCP. The woman, who had HCP, was receiving treatment with topical fentanyl patch and unspecified oral opioid analgesics [opioids; dosages not stated]. Over eight months, she had been hospitalised 14 times due to severe abdominal pain related to HCP. Fentanyl weaning had resulted in distress. Her fentanyl withdrawal symptoms had also contributed to frequent hospitalisation. She had been receiving high dose fentanyl persistently over six months without significant improvement. She was diagnosed with mild-moderate opioid use disorder. The woman was scheduled to be switched from fentanyl to long-acting maintenance therapy with sublingual buprenorphine/ naloxone [Suboxone]. An elective admission was arranged. Withdrawal was quantified using the Clinical Opioid Withdrawal Scale (COWS). Her fentanyl patch was removed at 8pm and all other unspecified oral opioids were ceased. Suboxone was initiated once COWS reached 12. She was initiated on buprenorphine/naloxone at an initial dose of 2mg, which was then gradually increased. COWS measurements was performed hourly, and buprenorphine/naloxone was administered as needed in increments from 2mg to 4mg. On day 2, the cumulative dose from day 1 was administered. The transition was well tolerated. She was discharged on day 7 on buprenorphine/naloxone 16mg daily. Following initiation of buprenorphine/naloxone therapy, her hospital admission frequency decreased to eight admissions over 23 months. Twenty-three months after the initiation of buprenorphine/naloxone therapy, she was weaned from buprenorphine/naloxone dose of 16mg to 12mg under the out-patient guidance of an addiction specialist. She developed withdrawal features during weaning [outcomes not stated]. Towns C, et al. Opioid dependence with successful transition to suboxone (buprenorphine/naloxone) in a young woman with hereditary coproporphyria. New Zealand Medical 803506751 Journal 133: 81-83, No. 1518, 17 Jul 2020. Available from: URL: https://pubmed.ncbi.nlm.nih.gov/32683436/
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Reactions 10 Oct 2020 No. 1825
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