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Current withdrawal symptoms included increased anxiousness; insomnia; body pain; gastrointestinal upset including nausea, vomiting, and diarrhea; and general malaise. He stated that oxycodone and hydrocodone were initially prescribed. Afterward, he attempted to maintain his habit by obtaining opiates online, which was largely motivated by his hearing impairment. Early in the course of his tapentadol abuse, he noted its efficacy was comparable to oxycodone, with decreased withdrawal symptoms when he ran out. The patient was started on medication-assisted treatment with buprenorphine-naloxone 8 mg; the dose was later increased to 16 mg. Metabolism occurs via phase II glucuronidation, and no significant cytochrome P contributions or polymorphisms have been described, minimizing concerns for drug interactions.

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