Successful treatment with slow-release oral morphine following afentanyl-related overdose: A case report

Abstract

Background: Overdose deaths as a result of untreated opioid use disorder (OUD) pose a major public health concern across North America. Although slow-release oral morphine (SROM) is increasingly used as an alternative option for the treatment of OUD, research on its efficacy among individuals exposed to illicit fentanyl or those with previous unsuccessful attempts with other opioid agonist therapies (OATs) is limited and controversial. Case: We present a case of a 48-year-old male with severe OUD seeking treatment following a near-fatal fentanyl overdose. His previous treatment attempts with methadone and buprenorphine/naloxone-based OAT had been unsuccessful. As per local guidelines, he was started on SROM with subsequent cessation of opioid cravings and illicit drug use. Discussion: This case report describes a patient entering early remission for OUD when treated with SROM following unsuccessful past treatment attempts on first-line oral medications. Future studies should seek to evaluate SROM-based OAT as a potential second-line treatment alternative for OUD.

Keywords:

• Buprenorphine
• fentanyl
• methadone
• opioid agonist therapy
• opioid use disorder
• slow-release oral morphine

Author contributions

G.P. and M.E.S. designed the study. G.P. prepared the first draft of the manuscript. All authors were involved in the interpretation of the findings, revising the manuscript, and approving the final version.

Acknowledgments

The authors would like to thank Isabella Tak for the administrative assistance.

Additional information

Funding

G.P. is supported by a Canada Addiction Medicine Research Fellowship (US National Institute on Drug Abuse, R25-DA037756). M.E.S. is supported by a Michael Smith Foundation for Health Research (MSFHR)/St Paul’s Foundation Scholar Award. K.A. is supported by a Canadian Institute of Health Research Embedded Clinician Scholar Award. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication