Which drug may cause confusion and drowsiness in older adults with opioid use disorder?

Buprenorphine is a partial opioid agonist commonly used in the treatment of opioid use disorder. It is effective in reducing cravings and withdrawal symptoms by activating the same receptors in the brain that other opioids do, albeit to a lesser extent. This characteristic can be particularly relevant in older adults who may be more sensitive to medications due to age-related physiological changes.

One reason buprenorphine can lead to confusion and drowsiness in older adults is that they often have altered pharmacokinetics, which can affect drug metabolism and clearance. Additionally, this population may already be taking other central nervous system (CNS) depressants, heightening the risk for sedative effects. Opioids, including buprenorphine, can impair cognitive function and sedate, making the elderly more susceptible to cognitive side effects.

In contrast, disulfiram is primarily used to aid in alcohol cessation, not opioid dependence, while topiramate is an anticonvulsant that may have some off-label uses but is not primarily indicated for opioid use disorder. Naltrexone, an opioid antagonist, works against the effects of opioids and does not commonly cause confusion or drowsiness; rather, it can precipitate withdrawal symptoms in individuals with an opioid