Methadone, Oxymorphone, and Nalbuthen

Methadone has equivalent potency to morphine but a longer duration of action and incredibly variable duration of action with a half life anywhere from 13 to 100 hours. Oxymorphone is 10 times more potent than morphine it has extensive liver metabolism and so not recommended in liver impairment. Tramadol which we see often also acts as a serotonin and norepinephrine reuptake inhibitor in addition to its opiate effects It's about one fifth to one tenth as potent as morphine it can cause seizures and interestingly it has some antibacterial action at least in the lab. Naloxone Narcan will still reverse these medications except it doesn't work as well for buprenorphine because