Initiation and Rapid Titration of Methadone in an Acute Care Setting for the Treatment of Opioid Use Disorder: A Case Report
Initiation and Rapid Titration of Methadone in an Acute Care Setting for the Treatment of Opioid Use Disorder: A Case Report
复制标题
DOI：
10.1097/adm.0000000000000507
复制
发表时间：
2019-09-01
影响因子：
5.5
通讯作者：
Nolan, Seonaid
中科院分区：
文献类型：
--
作者：
Hemmons, Patrick;Bach, Paxton;Nolan, Seonaid
背景资料：虽然美沙酮是阿片类药物使用障碍的有效治疗方法，但其启动需要以亚治疗剂量处方，随后在数周内滴定至治疗剂量。因此，美沙酮诱导期对个人来说可能是一个具有挑战性的时期，并且可能与持续使用非法药物并因此过量的风险增加有关。鉴于其定期临床评估的能力，急性护理环境可能提供一个独特的机会，以减少美沙酮维持治疗的诱导期的持续时间。病例总结：我们报告的情况下，一个人谁成功地完成启动和快速美沙酮滴定治疗阿片类药物使用障碍的急性护理环境。讨论内容：利用分开的给药间隔和定期监测毒性，患者在入院的前48小时内接受了总计130 mg的累积美沙酮剂量，随后继续类似剂量。在9天随访期内未发生不良事件。这里描述的病例报告强调了潜在的急性护理环境可能提供成功启动和快速滴定美沙酮治疗阿片类药物使用障碍。这种方法可以显着减少与美沙酮维持治疗相关的诱导期及其相关的负面结果，包括持续使用非法药物和过量的风险。
Background: Although methadone is an effective treatment for opioid use disorder, its initiation requires prescribing at a subtherapeutic dose with subsequent titration to a therapeutic dose over many weeks. Accordingly, the methadone induction period can be a challenging one for individuals and can be associated with an increased risk for ongoing illicit drug use and consequently overdose. Given its capacity for regular clinical assessments, acute care settings may offer a unique opportunity to reduce the duration of the induction period for methadone maintenance therapy. Case summary: We report a case of an individual who successfully completed initiation and rapid methadone titration for treatment of opioid use disorder in an acute care setting. Discussion: Utilizing divided dosing intervals and regular monitoring for toxicity, the patient received a cumulative methadone dose of 130 mg total within the first 48 hours of admission with continuation of a similar dose subsequently. No adverse events occurred over a 9-day follow-up period. The case report described here highlights the potential acute care settings may offer for the successful initiation and rapid titration of methadone for the treatment of opioid use disorder. Such an approach could significantly reduce the induction period associated with methadone maintenance therapy and its associated negative outcomes including ongoing illicit substance use and risk for overdose.