An adolescent who develops hallucinations after taking morphine is to be switched to an oral alternative. Which option is most appropriate?

• A. Oxycodone
• B. Fentanyl
• C. Tramadol
• D. Codeine

Answer: (A)

When morphine triggers hallucinations, the aim is to switch to an oral opioid with a different metabolic profile and a lower risk of central nervous system toxicity, while still providing effective analgesia. Codeine would be less suitable because it is converted to morphine in the body, so the same CNS effects could recur. Tramadol carries additional CNS effects through serotonin–norepinephrine activity and has seizure risk, making it a less predictable choice for neuropsychiatric side effects. Fentanyl, though a potent opioid, isn’t the typical oral switch in this context and involves different formulations and potency considerations. Oxycodone fits as an oral alternative with a different pharmacokinetic/metabolic profile and reliable oral availability, making it a sensible option to reduce the chance of morphine-related hallucinations while maintaining analgesia.