![]() 18– 26 Conversely, there have been reports of opioid-induced hallucinations, which are reversed by rotation to oxycodone. Most reports have cited morphine as the causative agent, but there is also a multitude of reports implicating fentanyl, methadone, tramadol, hydromorphone, buprenorphine, pentazocine, and oxycodone. They are often reported in patients with comorbidities that may predispose to hallucinations, yet they are also seen in patients without any underlying confounders. Many of these reports involve high-dose opioid regimens, both planned and accidental. 18 The majority of the literature arises from treatment during end-of-life care and cancer pain. Numerous reports exist of hallucinations attributed to opioids, which have been typically described as auditory, visual, or rarely tactile hallucinations. The word “hallucination” has its origin in the Latin root hallucinari or allucinari, which translates to “wander in mind.” 16 The following is the Diagnostic and Statistical Manual of Mental Disorders’ definition of a hallucination: “a perception like experience with the clarity and impact of a true perception but without the external stimulation of the relevant sensory organ.” 17 15 This review seeks to increase awareness of this potential complication through a discussion of the literature, potential mechanisms of action, diagnosis, and treatment strategies. This phenomenon is likely underreported because of the tolerable intensity of many hallucinations and fear associated with the stigma of being labeled as psychologically unstable. ![]() Opioid-induced hallucination is an uncommon yet significant adverse effect of opioid treatment, frequently attributed to underlying psychiatric disease or personality disorder rather than a direct neurobiologic effect of opioids. 5– 14 Other adverse effects whose incidences are more difficult to quantify include hyperalgesia, muscle rigidity, myoclonus, immunologic and hormonal dysfunction, physical dependence, tolerance, and addiction. 5, 6 Common adverse events noted across multiple studies include xerostomia (42%), constipation (20%–41%), diaphoresis (34%), weight gain (29%), somnolence (14%–29%), sleep disorders (25%), memory deficits (24%), decreased appetite (23%), nausea (17%–33%), concentration deficits (19%), fatigue (19%), sexual dysfunction (18%), dizziness (12%–22%), emesis (11%–15%), pruritus/dry skin (10%), and urinary retention (4%–18%). Up to 80% of patients treated with opioids experience a minimum of 1 adverse event. ![]() 4 The most common adverse effects are gastrointestinal and central nervous system-related. At the extreme, 16,235 of 22,235 (71.3%) pharmaceutical over-dose deaths in 2013 involved opioid analgesics. Opioid therapy may be associated with adverse effects. The economic loss of pain conditions to the United States in 2007 was estimated to be a total of $55.7 billion with workplace costs accounting for $25.6 billion (46%) and health care costs accounting for $25.0 billion (45%). Treatment of pain conditions is at the forefront of public debate. Hence, knowledge of the pharmacology and potential adverse effects of these drugs is required. With a forecasted increase in the patient-to-physician ratio, opioid therapy is predicted to be provided by practitioners of varying backgrounds and medical specialties. ![]() 1, 2 Although the use of opioid therapy for noncancer pain remains controversial, it is utilized in the treatment for a multitude of conditions. Opioid prescription for both chronic cancer and non-cancer pain has been steadily increasing over the past few decades. This review seeks to increase awareness of this potential complication through a discussion of the literature, potential mechanisms of action, diagnosis, and treatment strategies. Hence, knowledge of the pharmacology and potential adverse effects of these agents is required. Because the rate of opioid prescriptions continues to increase in the population, the rate of opioid-associated hallucinations may also conceivably increase. The majority of the litera-ture concerning opioid-induced hallucinations arises from treatment during end-of-life care and cancer pain. The practitioner may encounter patient reluctance to volunteer the occurrence of this phenomenon because of fears of being judged mentally unsound. Opioid-induced hallucination is an uncommon yet significant adverse effect of opioid treatment. Despite their association with multiple adverse effects, opioid prescription continues to increase. ![]()
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