Patient With Very High Opioid Tolerance Enrolled in Opioid Agonist Treatment: A Case Report

Abstract

Background: Fentanyl and fentanyl analogs have invaded the streetsourced opioid market in North America which has resulted in an unprecedented number of unintentional opioid overdoses. Existing guidelines to treat opioid use disorder are based on evidence that was developed when heroin was the primary street-sourced opioid and proposed dosages of opioid agonist treatments are increasingly inadequate to address patients with high opioid tolerances. Case Summary: The authors examine one case study of a patient with an extremely high opioid tolerance and review how responsive dose adjustments outside of the recognized maximum doses allowed for meaningful functional outcomes. Discussion: This case demonstrates how patient-centered dose responses with a focus on functional outcomes supersede existing opioids agonist treatment dosing ranges, especially in the context of a patient with a higher than typical opioid tolerance.

Sensorimotor Alterations Induced by Novel Fentanyl Analogs in Mice: Possible Impact on Human Driving Performances

“…No significant effect was seen on attention, reaction, visual orientation, motor co-ordination and vigilance [ 3 , 12 ]. This is expected, given the well-described mechanisms of tolerance in opioids and FENT users [ 13 , 14 ]. As shown for prescription opioids, it is likely that the recreational use of NSO, alternating high doses and abstinence periods, might result in a lower tolerance development and in a higher risk for driving [ 2 ].…”