title: Sustained release oral morphine as an alternative to methadone for the treatment of opioid-use disorder post Torsades de Pointes cardiac arrest.
abstract: In most settings, approved medications for the treatment of opioid-use disorder include methadone and buprenorphine/naloxone, and in some settings, naltrexone. We present a case in which methadone administration was associated with an in-hospital episode of Torsades de Pointes in a patient who was subsequently maintained on sustained release oral morphine (SROM) for treatment of his opioid-use disorder. This transition was made in the context of long-term compliance to methadone maintenance, and with a previous adverse reaction to buprenorphine/naloxone precluding its use. The change to SROM, supported by emerging evidence, resulted in a reduction in the patient's measured QTc interval, prevention of further arrhythmias and continued abstinence from illicit opioid-use. In this context, we believe careful consideration should be given to the use of SROM.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Walton
authors.affiliation: Department of Medicine, Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Seonaid
authors.initials: S
authors.lastname: Nolan
authors.affiliation: Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Christy
authors.initials: C
authors.lastname: Sutherland
authors.affiliation: Department of Family Medicine, Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Keith
authors.initials: K
authors.lastname: Ahamad
mesh_terms: D000284:Administration, Oral; D003692:Delayed-Action Preparations; D004562:Electrocardiography; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D016171:Torsades de Pointes / Q000139:chemically induced*
chemical_list: D003692:Delayed-Action Preparations; D009020:Morphine; D008691:Methadone