A patient with a history of intravenous drug use requires sedation. Which agent should generally be AVOIDED?

Correct answer: C. Fentanyl

• A. Nitrous oxide/oxygen is generally considered acceptable, though some recovery programs discourage any mind-altering agent — discuss with the patient and their treatment team.
• B. Acetaminophen and NSAIDs are the analgesics of choice in this population.
• C. CORRECT — avoid. FENTANYL is a potent synthetic OPIOID. In a patient with opioid use disorder, administering an opioid risks precipitating relapse in a person in recovery, carries unpredictable dose-response due to tolerance or to concurrent illicit use, and creates a serious respiratory depression hazard when combined with unknown street drugs already on board. In addition, patients on buprenorphine or methadone maintenance have blocked or altered receptor responses.
• D. Plain local anesthetic is safe and is often the preferred approach; consider avoiding epinephrine in a patient who may have used cocaine or methamphetamine within 24 hours.

Note: Also note: NEVER give a vasoconstrictor within 24 hours of cocaine or methamphetamine use — the combination can produce severe hypertension, arrhythmia, and MI.