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MPs and NPs cause intestinal dysbiosis, a marked decrease in abundance of immune function-associated bacteria (42), an increase in the number of pathogenic bacterial colonies and a decrease in the number of CD4+ T helper 17 and regulatory T cells, leading to an immune imbalance, as well as an increase in plasma lipopolysaccharides (57), which stimulate intestinal inflammation (41)

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As of September 2023 it is on the FDA's Category 2 list of bulk drug substances that may not be compounded due to significant safety risks, and the agency has scheduled a Pharmacy Compounding Advisory Committee (PCAC) review for July 2026 covering proposed uses in opioid withdrawal, chronic insomnia, and narcolepsy