Pharmacopsychiatry 2024; 57(02): 88
DOI: 10.1055/s-0044-1779563
Abstracts │ XVth Symposium of the Task Force Therapeutic Drug Monitoring of the AGNP
Lecture Abstracts

Degree of clinically quantified tolerance to the desired effects of and adverse drug reactions to the full mu opiod receptor agonist morphine, methadone and fentanyl and to the partial agonist buprenorphine during opioid maintenance and analgesic treatment

G. Zernig
1   Department of Pharmacology, Medical University Innsbruck, and private practice for psychotherapy and court-certified witness, Hall in Tirol, Austria. gerald.zernig@i-med.ac.at, office@zerniglabor.at
› Author Affiliations
 

Mu opioid analgesics like the full mu opioid receptor agonists morphine, methadone and fentanyl or the partial agonist buprenorphine have remained the mainstay in the treatment of moderate to severe pain. During chronic treatment, the development of tolerance to their antinociceptive effects presents a considerable therapeutic challenge, especially in opioid maintenance patients who, to complicate matters, may or may not abuse opioids on the side. In opioid-based maintenance patients, it is desirable to assess the actual degree of tolerance to effectively treat withdrawal symptoms while avoiding illegal diversion of surplus quantities of the prescribed mu opioid agonist. As a further complication, the degree of tolerance may vary considerably among different opioid effects.

We are currently conducting a systematic review (PROSPERO CRD42023408416) of the quantitative evidence for these varying degrees of tolerance in either patient population (patients with primary opioid dependence, PODs vs ‘regular’ patients, REGs) for the various desired effects of and adverse drug reactions to morphine, methadone, fentanyl, and buprenorphine.

A preliminary analysis indicates that tolerance to antinociceptive opioid effects in PODs is more than 6-fold (buprenorphine maintenance) to more than 7-fold (methadone maintenance). Of special consideration, no tolerance to the respiratory depressant effect in PODs seems to occur under these controlled conditions.



Publication History

Article published online:
12 March 2024

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