Medical Emergencies · patient case question
Given his history of opioid use disorder in recovery, which medication is most important to avoid?
Patient case: Liver disease and a history of substance use
Patient: Male, 51 years old
Chief Complaint: Presents after surgical extraction of two mandibular molars and asks what to take for the pain.
Background: Hepatitis B and hepatitis C. Long history of heavy alcohol use, now six months abstinent. Past opioid use disorder, currently in recovery and attending a programme.
Vital Signs: BP 128/80 mmHg · HR 78 bpm
Laboratory: Elevated transaminases. INR 1.6. Platelets 118,000/µL.
Show answer and explanation
Correct answer: A. Fentanyl
- A. CORRECT. FENTANYL is a high-potency synthetic mu agonist with rapid onset — precisely the profile most likely to trigger relapse in a patient in recovery, and the one most associated with overdose. Prescribing any opioid to a patient in recovery requires a compelling indication, the shortest possible course, and ideally coordination with the treating physician or recovery programme. Fentanyl specifically should be avoided in the outpatient dental setting for this patient.
- B. Ibuprofen is a non-opioid with no abuse liability. It carries its own risks here from the liver disease and bleeding parameters, but not from the addiction history.
- C. Amoxicillin is an antibiotic with no relevance to substance use risk.
- D. Acetaminophen has no abuse potential. Its constraint in this patient is hepatic dose limitation.
Practice Medical Emergencies questions Medical Emergencies study notes