Tamaskar Ranjit, Parran Theodore V, Heggi Abdul, Brateanu Andrei, Rabb Mary, Yu Jaehak
Department of Medicine, Huron Hospital, 13591 Terrace Road, E Cleveland, OH 44112, USA.
J Addict Dis. 2003;22(4):5-12. doi: 10.1300/j069v22n04_02.
Various drugs have been used for the treatment of opioid withdrawal, e.g., methadone, buprenorphine, and clonidine. Tramadol is a centrally acting synthetic analgesic agent with opiate activity due to low affinity binding of the parent compound and higher affinity binding of the O-demethylated metabolite M1 to mu opioid receptors. As a consequence, there may be a role for the use of tramadol in the treatment of opiate withdrawal. We attempt to assess the efficacy of tramadol in treating moderate heroin withdrawal through a retrospective cohort control study, conducted in a detoxification unit in a community teaching hospital. Out of 100 heroin abusers admitted for detoxification during the review period, 64 patients who were treated either with buprenorphine or tramadol, were included in this study, with 20 participants in the buprenorphine group and 44 in the tramadol group. Both groups were matched for age, sex, and self-reported average quantity of heroin used per day. In the tramadol group, the average CINA maximum was 9.0, and in the buprenorphine group it was 11.2 (P = 0.07). The use of oral clonidine per patient in the tramadol group was 1.6 tablets, and in the buprenorphine group 0.1 tablets (P = 0.002). The length of stay was 3.7 days in the tramadol group and 4.1 days in the buprenorphine group (P = 0.5). Four participants in the tramadol group received three or more doses of buprenorphine because their symptoms were not controlled, and were considered as treatment failures. These preliminary data suggest that tramadol may be comparable to buprenorphine in the management of mild to moderately severe heroin withdrawal. These findings, if reproduced in larger studies with stronger research designs, have potentially great implications for the management of opioid withdrawal in both the inpatient and outpatient setting.
各种药物已被用于治疗阿片类药物戒断，例如美沙酮、丁丙诺啡和可乐定。曲马多是一种中枢性合成镇痛药，由于母体化合物的低亲和力结合以及O-去甲基代谢物M1与μ阿片受体的高亲和力结合而具有阿片样活性。因此，曲马多在治疗阿片类药物戒断中可能有一定作用。我们试图通过一项在社区教学医院戒毒科进行的回顾性队列对照研究，评估曲马多治疗中度海洛因戒断的疗效。在回顾期内入院戒毒的100名海洛因滥用者中，64名接受丁丙诺啡或曲马多治疗的患者被纳入本研究，丁丙诺啡组20名参与者，曲马多组44名。两组在年龄、性别和自我报告的每日海洛因平均使用量方面进行了匹配。曲马多组的平均临床研究所用阿片类药物戒断症状评估量表（CINA）最大值为9.0，丁丙诺啡组为11.2（P = 0.07）。曲马多组每位患者口服可乐定的用量为1.6片，丁丙诺啡组为0.1片（P = 0.002）。曲马多组的住院时间为3.7天，丁丙诺啡组为4.1天（P = 0.5）。曲马多组有4名参与者因症状未得到控制而接受了三剂或更多剂量的丁丙诺啡，被视为治疗失败。这些初步数据表明，在治疗轻度至中度重度海洛因戒断方面，曲马多可能与丁丙诺啡相当。如果在设计更强的大型研究中得到重现，这些发现对住院和门诊环境中的阿片类药物戒断管理可能具有重大意义。
