{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:20:38Z","timestamp":1792099238016,"version":"4.4.0"},"reference-count":22,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"2","license":[{"start":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:00:00Z","timestamp":1617148800000},"content-version":"vor","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The interaction between methadone and central nervous system depressants can cause serious adverse effects, including profound sedation, respiratory depression, coma, and death. This poses a challenge in the treatment of patients with concurrent psychiatric and substance use disorders as the combined use is often unavoidable. We report a case of a patient with opioid use disorder, mood disorder unspecified, chronic pain, and chronic obstructive pulmonary disease who experienced 2 serious episodes of CNS and respiratory depression due to polypharmacy-induced opioid toxicity. Careful consideration of pharmacokinetics, pharmacodynamics, and patient-specific factors was imperative to identify the suspected contributing medications: methadone, lorazepam, divalproex, gabapentin, and cyclobenzaprine. Cognitive and system factors that contributed to these adverse events and strategies to mitigate risk of recurrence were also identified.<\/jats:p>","DOI":"10.9740\/mhc.2021.03.070","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T13:59:40Z","timestamp":1617199180000},"page":"70-74","source":"Crossref","is-referenced-by-count":6,"title":["Opioid toxicity due to CNS depressant polypharmacy: A case report"],"prefix":"10.9740","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8150-7468","authenticated-orcid":true,"given":"Christine","family":"Lee","sequence":"first","affiliation":[{"name":"BSP Candidate 2020, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8920-5819","authenticated-orcid":true,"given":"Annabelle","family":"Wanson","sequence":"additional","affiliation":[{"name":"Assistant Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5079-9197","authenticated-orcid":true,"given":"Sarah","family":"Frangou","sequence":"additional","affiliation":[{"name":"Psychiatry PGY-5, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0545-6528","authenticated-orcid":true,"given":"David","family":"Chong","sequence":"additional","affiliation":[{"name":"Psychiatry PGY-5, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6141-0439","authenticated-orcid":true,"given":"Katelyn","family":"Halpape","sequence":"additional","affiliation":[{"name":"(Corresponding author) Assistant Professor, College of Pharmacy and Nutrition, University of Saskatchewan 2A20.01 Health Sciences, Saskatoon, Saskatchewan, Canada, katelyn.halpape@usask.ca"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4719","published-online":{"date-parts":[[2021,3,31]]},"reference":[{"key":"2021033113592213300_i2168-9709-11-2-70-b01","unstructured":"British Columbia Centre on Substance Use [Internet].\n          A guideline for the clinical management of opioid use disorder\n          [updated\n          2017\n          Jun;\n\t\t\t\t\tcited 2020 Sep 2].Available from: https:\/\/www.bccsu.ca\/wp-content\/uploads\/2017\/06\/BC-OUD-Guidelines_June2017.pdf"},{"key":"2021033113592213300_i2168-9709-11-2-70-b02","doi-asserted-by":"crossref","unstructured":"Weschules\n              DJ,\n            \n            \n              Bain\n              KT,\n            \n            \n              Richeimer\n              S.\n            \n          \n          Actual and potential drug interactions associated with methadone.\n\t\t\t\t\tPain Med.\n\t\t\t\t\t2008;\n\t\t\t\t\t9(3):\n\t\t\t\t\t315-\n\t\t\t\t\t44.\n\t\t\t\t\tDOI: 10.1111\/j.1526-4637.2006.00289.x. 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