A 28-year-old man dependent on heroin is enrolled in a medication-assisted treatment program. He is started on a medication that, at therapeutic doses, occupies opioid receptors without producing significant euphoria and blocks the effects of additional opioid use, thus discouraging craving-driven use. Which medication is being described?
- A Methadone
- B Naloxone
- C Buprenorphine ✓
- D Naltrexone
Explanation
Buprenorphine is a partial mu-opioid agonist with very high receptor affinity, producing a ceiling effect that limits euphoria and respiratory depression at therapeutic doses while reducing craving. It is commonly combined with naloxone (as Suboxone) to deter intravenous misuse — the naloxone component has negligible sublingual absorption but precipitates withdrawal if injected. Methadone is a full agonist with higher abuse potential. Naltrexone is a pure opioid antagonist with no agonist activity, used for relapse prevention after detoxification rather than substitution therapy.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.