Oral complications from sublingual buprenorphine treatment: A prospective cohort study

项目摘要/摘要 对抗阿片类药物过量危机的一个至关重要的干预措施是丁丙诺啡，一种部分阿片类药物 可将过量服药死亡率降低高达70%的激动剂。丁丙诺啡在以下情况下具有广泛的首过效应 口服，需要舌下(SL)给药途径，显著提高生物利用度。 为了进一步最大限度地吸收，阿片使用障碍(OUD)患者被指示等待 药物完全溶解并被吸收，可能需要5到10分钟甚至更长时间，通常需要多次服用 一天几次。患者也会长期接受丁丙诺啡治疗，通常是多年。AS 这样，OUD患者的口腔可能会经历SL丁丙诺啡的大量累积暴露 在治疗过程中。2022年，FDA警告临床医生和患者口腔并发症可能 因使用SL丁丙诺啡而引起，包括龋齿、龋齿、口腔感染和牙齿脱落。而当 认识到丁丙诺啡在减少阿片类药物相关不良后果风险方面的重要性， 通知建议在处方信息中包括此类牙科并发症，并包括 丁丙诺啡治疗期间维持口腔健康的策略。不幸的是，支持的证据基础 这一警告在很大程度上是基于病例报告/系列。此外，由于患有自闭症的人很少 接受牙科治疗，这种牙科问题在多大程度上是由丁丙诺啡的直接作用引起的，或者 与丁丙诺啡无关的因素，目前仍不清楚。为了满足这一需求，我们建议进行一次前瞻性的 接受SL丁丙诺啡或美沙酮维持治疗的OUD患者的队列研究。 口腔疾病的患病率和其他口腔健康结果将在注册时进行评估，然后 在6个月和12个月时进行前瞻性重新评估。具体地说，我们将评估自我报告的口腔健康状况为 以及牙釉质损失和龋齿使用便携式口腔内3D扫描仪，也利用近红外- 红色成像技术。作为次要目标，我们将对有OUD的个人进行定性研究，以更好地 了解接受口腔保健的促进者和障碍。我们还将采访OUD治疗 提供者和牙医，询问如何改善患有口腔溃疡的个人的口腔保健。结果是 将有助于设计一项针对预防和治疗中可改变的风险因素的临床试验 口腔疾病与口腔疾病的关系。这一创新的R21提案响应了NIDA和NIDCR 规划目标和RFA-DE-23-015通过研究慢性阻塞性肺疾病患者口腔并发症的发展 乌德接受丁丙诺啡。

Project summary/abstract A critically important intervention to combat the opioid overdose crisis is buprenorphine, a partial-mu opioid agonist that reduces overdose mortality by up to 70%. Buprenorphine undergoes extensive first-pass effect when taken orally, necessitating the sublingual (SL) route of administration which significantly increases bioavailability. To further maximize the absorption, patients with opioid use disorder (OUD) are instructed to wait for the medication to fully dissolve and be absorbed, which can take 5 to 10 minutes or even longer, often taken multiple times a day. Patients also remain on buprenorphine treatment for a prolonged period, often for many years. As such, the oral cavity of OUD patients may experience substantial cumulative exposure to SL buprenorphine during treatment. In 2022, the FDA warned clinicians and patients of the possibility that oral complications may arise from the use of SL buprenorphine, including tooth decay, cavities, oral infections, and tooth loss. While acknowledging the importance of buprenorphine in mitigating the risk for opioid-related adverse outcomes, the notice recommended the inclusion of such dental complications in the prescribing information, and to include strategies to maintain oral health during buprenorphine treatment. Unfortunately, the evidence-base in support of this warning is largely based on case reports/series. In addition, since individuals with OUD infrequently receive dental treatment, to what extent such dental issues arose from the direct effects of SL buprenorphine, or from factors unrelated to buprenorphine, remains unknown. To fill this need, we propose to conduct a prospective cohort study of individuals with OUD receiving either SL buprenorphine or methadone for maintenance treatment. The prevalence of oral diseases and other oral health outcomes will be assessed at enrollment, then prospectively re-assessed at 6- and 12- months. Specifically, we will assess self-reported oral health status as well as tooth enamel loss and dental caries using a portable intra-oral 3D scanner that also utilizes near infra- red imaging technology. As a secondary aim, we will conduct a qualitative study of individuals with OUD to better understand the facilitators and barriers to receiving oral health care. We will also interview OUD treatment providers and dentists to inquire about how to improve oral health care among individuals with OUD. The results from this trial will help inform the design of a clinical trial targeting modifiable risk factors in preventing and treating oral diseases among OUD patients. This innovative R21 proposal is responsive to NIDA and NIDCR programmatic goals and RFA-DE-23-015 by studying the development of oral complications among patients with OUD receiving SL buprenorphine.