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.