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We report 11 cases of opioid withdrawal syndrome after a single dose of nalmefene in patients usually treated with methadone, buprenorphine, but also with fentanyl or loperamide. Nalmefene is both a partial agonist and an antagonist of opioid receptors. Regarding to its opioid antagonist activity, nalmefene is contraindicated in patients with an opioid treatment. Therefore, when prescribing or delivering nalmefene, healthcare professionals need to be vigilant about any type of opioid exposure, even masked or hidden, to avoid these potential life\u2010threatening syndromes.<\/jats:p>","DOI":"10.1111\/fcp.12286","type":"journal-article","created":{"date-parts":[[2017,3,22]],"date-time":"2017-03-22T05:46:16Z","timestamp":1490161576000},"page":"574-579","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Opioid substitution therapy or hidden opioids are a minefield for nalmefene: an atypical case series of 11 patients in Lorraine"],"prefix":"10.1111","volume":"31","author":[{"given":"Melissa","family":"Y\u00e9l\u00e9h\u00e9\u2010Okouma","sequence":"first","affiliation":[{"name":"Centre R\u00e9gional de Pharmacovigilance de Lorraine Laboratoire de Pharmacologie Clinique et de Toxicologie CHRU de Nancy H\u00f4pital Central 29 avenue du Mar\u00e9chal de Lattre de Tassigny, CO 60034 54035 Nancy cedex France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Herv\u00e9","family":"Martini","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine L \/ Addictologie CHRU de Nancy H\u00f4pitaux de Brabois \u2010 B\u00e2timent Philippe Canton Rue du Morvan 54500 Vand\u0153uvre\u2010l\u00e8s\u2010Nancy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00e9r\u00e9mie","family":"Lemari\u00e9","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale CHRU de Nancy H\u00f4pital Central 29 avenue du Mar\u00e9chal de Lattre de Tassigny, CO 60034 54035 Nancy cedex France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Labroca","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale H\u00f4pital de Mercy CHR Metz\u2010Thionville 1, all\u00e9e du ch\u00e2teau, CS 45001 57085 Metz cedex 03 France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine","family":"Petitpain","sequence":"additional","affiliation":[{"name":"Centre R\u00e9gional de Pharmacovigilance de Lorraine Laboratoire de Pharmacologie Clinique et de Toxicologie CHRU de Nancy H\u00f4pital Central 29 avenue du Mar\u00e9chal de Lattre de Tassigny, CO 60034 54035 Nancy cedex France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Val\u00e9rie","family":"Gibaja","sequence":"additional","affiliation":[{"name":"Centre d'Addictovigilance de Nancy H\u00f4pital Central Pavillon Bruillatre\u2010Balbatre, 29, avenue du Mar\u00e9chal de Lattre de Tassigny, CO 60034 54035 NANCY Cedex France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois","family":"Paille","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine L \/ Addictologie CHRU de Nancy H\u00f4pitaux de Brabois \u2010 B\u00e2timent Philippe Canton Rue du Morvan 54500 Vand\u0153uvre\u2010l\u00e8s\u2010Nancy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0598-7508","authenticated-orcid":false,"given":"Pierre","family":"Gillet","sequence":"additional","affiliation":[{"name":"Centre R\u00e9gional de Pharmacovigilance de Lorraine Laboratoire de Pharmacologie Clinique et de Toxicologie CHRU de Nancy H\u00f4pital Central 29 avenue du Mar\u00e9chal de Lattre de Tassigny, CO 60034 54035 Nancy cedex France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,5,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/SAR.S45666"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms17081216"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2016.1146689"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001924"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1024\/1661-8157\/a002160"},{"issue":"1","key":"e_1_2_7_7_1","first-page":"58","article-title":"Nalmefene and opioids: a contra\u2010indication to remember","volume":"30","author":"Yelehe\u2010Okouma M.","year":"2016","journal-title":"Fundam. 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