Inpatient Low-dose Transitions From Full Agonist Opioids Including Methadone Onto Long-acting Depot Buprenorphine: Case Series From a Multicenter Clinical Trial.
Inpatient Low-dose Transitions From Full Agonist Opioids Including Methadone Onto Long-acting Depot Buprenorphine: Case Series From a Multicenter Clinical Trial.
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住院患者从包括美沙酮在内的全激动阿片类药物到长效丁丙诺啡的低剂量过渡：来自多中心临床试验的病例系列。
DOI：
10.1097/adm.0000000000001136
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发表时间：
2023
影响因子：
5.5
通讯作者：
Springer,SandraA
中科院分区：
文献类型：
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作者：
Seval,Nikhil;Nunez,Johnathan;Roth,Prerana;Schade,Meredith;Strong,Michelle;Frank,CynthiaA;Litwin,AlainH;Levin,FrancesR;Brady,KathleenT;Nunes,EdwardV;Springer,SandraA
目的 患有阿片类药物使用障碍 (OUD) 的人因需要住院治疗的严重成瘾相关感染而遭受不成比例的发病率和死亡率。长效丁丙诺啡 (LAB) 是一种未充分使用的 OUD 药物，在出院前服用可促进护理和治疗保留的联系。在住院患者中转用丁丙诺啡通常会因疼痛、积极的感染管理、潜在的手术干预以及从完全激动剂过渡到部分激动剂时阿片类药物戒断的风险而变得复杂。 方法 COMMIT 试验是一项随机对照试验，评估传染病医生和住院医师给予的 LAB 与常规治疗相比，对因感染住院的 OUD 患者进行治疗。我们报告了一系列使用全激动剂阿片类药物（包括美沙酮）的参与者的病例系列，他们使用低剂量（微剂量）策略过渡到舌下含服丁丙诺啡，然后注射 LAB。 结果 7 名目前患有阿片类药物使用障碍和危及生命的感染的参与者，均伴有明显的并发疼痛，许多人需要手术干预，从含服丁丙诺啡剂量开始，剂量范围为 225 μg 至 300 μg，共 3 次，进行了低剂量转换第一天的一天。所有患者均耐受良好，注射 LAB 的平均时间为 7.5 天（范围为 5-10 天）。结论 即使对于因并发感染和/或手术而住院的患者，将低剂量丁丙诺啡从全激动剂阿片类药物（包括美沙酮）过渡到 LAB 也是可行的。当阿片类药物复发和过量的风险很大时，该策略有助于在出院前服用 LAB。
ObjectivesPersons with opioid use disorder (OUD) suffer disproportionately from morbidity and mortality related to serious addiction-related infections requiring hospitalization. Long-acting buprenorphine (LAB) is an underused medication for OUD that may facilitate linkage to care and treatment retention when administered before hospital discharge. Transition onto buprenorphine in the inpatient setting is often complicated by pain, active infection management, potential surgical interventions, and risk of opioid withdrawal in transition from full agonists to a partial agonist.MethodsThe COMMIT Trial is a randomized controlled trial evaluating LAB administered by infectious disease physicians and hospitalists compared with treatment as usual for persons with OUD hospitalized with infections. We report a case series of participants on full agonist opioids including methadone who were transitioned to sublingual buprenorphine using low-dose (microdosing) strategies followed by LAB injection.ResultsSeven participants with current opioid use disorder and life-threatening infections, all with significant concurrent pain and many requiring surgical intervention, underwent low-dose transitions starting at buccal buprenorphine doses ranging from 225 μg to 300 μg 3 times a day on the first day. All were well tolerated with average time to LAB injection of 7.5 days (range, 5–10 days).ConclusionsInpatient low-dose buprenorphine transition from full agonist opioids including methadone onto LAB is feasible even in those with complex hospitalizations for concurrent infections and/or surgery. This strategy facilitates dosing of LAB before hospital discharge when risk of opioid relapse and overdose are significant.