Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series.
Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series.
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DOI：
10.1002/emp2.12880
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发表时间：
2023-02
影响因子：
2.3
通讯作者：
Kilaru, Austin S. S.
中科院分区：
文献类型：
--
作者：
Spadaro, Anthony;Faude, Sophia;Perrone, Jeanmarie;Thakrar, Ashish P. P.;Lowenstein, Margaret;Delgado, M. Kit;Kilaru, Austin S. S.
丁丙诺啡是一种治疗阿片类药物使用障碍的高效药物，但它会导致阿片类药物的快速戒断（PW）。PW的发病率、危险因素和最佳治疗方法尚不清楚。我们的目的是描述急诊科（艾德）患者丁丙诺啡给药后的不良结局，并评估他们是否符合PW的标准。本研究是一个病例系列，采用回顾性图表审查，在方便的样本患者从3家医院在城市学术卫生系统。本研究纳入了临床医生报告为潜在PW病例的患者。使用结构化的回顾性图表审查工具从电子健康记录中提取相关临床数据。共纳入13例病例，并将其分为以下3类：（1）丁丙诺啡给药后PW符合指南（n = 5），（2）偏离指南后PW（n = 4），和（3）阿片类药物长期戒断，临床阿片类药物戒断量表评分未增加（n = 4）。共有11名患者的芬太尼尿液药物检测呈阳性，11名患者接受了额外剂量的丁丙诺啡进行症状管理。在这些患者中，5例患者自行出院，6例患者最终出院，并开具了丁丙诺啡处方。在艾德和医院接受丁丙诺啡给药后的不良结局病例符合PW标准，尽管某些病例可能代表阿片类药物长期戒断。需要进一步调查PW的发生率、风险因素、管理以及患者观点，以扩大和维持丁丙诺啡在急诊室和医院的使用。
Buprenorphine is a highly effective medication for the treatment of opioid use disorder, but it can cause precipitated withdrawal (PW) from opioids. Incidence, risk factors, and best approaches to management of PW are not well understood. Our objective was to describe adverse outcomes after buprenorphine administration among emergency department (ED) patients and assess whether they met the criteria for PW. This study is a case series using retrospective chart review in a convenience sample of patients from 3 hospitals in an urban academic health system. This study included patients who were reported by clinicians as potential cases of PW. Relevant clinical data were abstracted from the electronic health record using a structured retrospective chart review instrument. A total of 13 cases were included and classified into the following 3 categories: (1) PW after buprenorphine administration consistent with guidelines (n = 5), (2) PW after deviating from guidelines (n = 4), and (3) protracted opioid withdrawal with no increase in Clinical Opiate Withdrawal Scale score (n = 4). A total of 11 patients had urine drug testing positive for fentanyl, and 11 patients received additional doses of buprenorphine for symptom management. Of the patients, 5 had self‐directed hospital discharges, and 6 were ultimately discharged with prescriptions for buprenorphine. Cases of adverse outcomes after buprenorphine administration in the ED and hospital meet criteria for PW, although some cases may have represented protracted opioid withdrawal. Further investigation into the incidence, risk factors, management of PW as well as patient perspectives is needed to expand and sustain the use of buprenorphine in EDs and hospitals.
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影响因子：
3.6
作者：
Spadaro, Anthony;Long, Brit;Perrone, Jeanmarie
通讯作者：
Perrone, Jeanmarie
DOI：
10.1111/ajad.13069
发表时间：
2021-01
期刊：
The American journal on addictions
影响因子：
--
作者：
Antoine D;Huhn AS;Strain EC;Turner G;Jardot J;Hammond AS;Dunn KE
通讯作者：
Dunn KE
DOI：
10.1002/emp2.12606
发表时间：
2021-12
影响因子：
2.3
作者：
Guo CZ;D'Onofrio G;Fiellin DA;Edelman EJ;Hawk K;Herring A;McCormack R;Perrone J;Cowan E
通讯作者：
Cowan E
影响因子：
7.6
作者：
HUNT, RJ
通讯作者：
HUNT, RJ
影响因子：
2.2
作者：
Gregory, Katherine E.;Radovinsky, Lucy
通讯作者：
Radovinsky, Lucy