Threlkeld Melinda, Parran Theodore V, Adelman Christopher A, Grey Scott F, Yu Jaehak
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Am J Addict. 2006 Mar-Apr;15(2):186-91. doi: 10.1080/10550490500528712.
Many medications have been used over the past thirty years for the treatment of opioid withdrawal, including propoxyphene, methadone, clonidine, parenteral buprenorphine, and, more recently, sublingual buprenorphine. Each has been found to have clinical strengths and limitations. Tramadol is a centrally acting synthetic analgesic with opiate activity primarily due to the binding of a metabolite to the micro receptor. Despite this micro receptor activity, tramadol appears to have low abuse potential and is a non-scheduled analgesic. The pharmacologic profile of tramadol makes it a candidate for opiate withdrawal treatment. A chart review was undertaken to retrospectively compare treatment outcomes of heroin-dependent patients when detoxified with parenteral buprenorphine (1996-1997) versus tramadol (1999-2000). Inclusion criteria for this study were heroin as drug of choice, current opioid physical dependence (ie, withdrawal symptoms), no current abuse of oral opioid analgesics, and no alcohol or benzodiazepine withdrawal symptoms. Patient cases that met inclusion criteria were group-matched between buprenorphine and tramadol on the basis of age, sex, and amount of heroin used (bags/day). Charts were audited for patient demographics, daily heroin use at admission, withdrawal symptoms, and discharge status. In total, 129 patient charts were reviewed, and 115 met all inclusion criteria and were group-matched (45 patients in the buprenorphine group, seventy in the tramadol group). There were no differences in demographics between the two groups of patients. Fifty-six percent of the buprenorphine group and 71% of the tramadol group completed detoxification; tramadol-treated patients had significantly higher average withdrawal symptoms when compared to the buprenorphine group and a greater reduction in withdrawal symptoms over time. Finally, the number of side effects was small and did not differ between the groups. The results of this study are consistent with previous pilot reports that indicated few clinical differences between parenteral buprenorphine and oral tramadol protocols when used in the management of acute heroin withdrawal. As a consequence, tramadol shows some promise as an opioid withdrawal management medication.
在过去三十年中，许多药物被用于治疗阿片类药物戒断，包括丙氧芬、美沙酮、可乐定、肠胃外注射用丁丙诺啡，以及最近的舌下含服丁丙诺啡。每种药物都有其临床优势和局限性。曲马多是一种中枢性合成镇痛药，具有阿片样活性，主要是由于一种代谢产物与微受体结合。尽管有这种微受体活性，但曲马多的滥用潜力似乎较低，是一种非管制类镇痛药。曲马多的药理特性使其成为阿片类药物戒断治疗的候选药物。我们进行了一项图表回顾，以回顾性比较海洛因依赖患者分别接受肠胃外注射用丁丙诺啡（1996 - 1997年）和曲马多（1999 - 2000年）脱毒治疗后的结果。本研究的纳入标准为：选择海洛因为药物，目前存在阿片类药物身体依赖（即戒断症状），目前未滥用口服阿片类镇痛药，且无酒精或苯二氮䓬类药物戒断症状。符合纳入标准的患者病例，根据年龄、性别和海洛因使用量（袋/天）在丁丙诺啡组和曲马多组之间进行组间匹配。对图表进行审核，记录患者人口统计学信息、入院时每日海洛因使用量、戒断症状和出院状态。总共审查了129份患者图表，其中115份符合所有纳入标准并进行了组间匹配（丁丙诺啡组45例患者，曲马多组70例患者）。两组患者的人口统计学特征没有差异。丁丙诺啡组56%的患者和曲马多组71%的患者完成了脱毒治疗；与丁丙诺啡组相比，接受曲马多治疗的患者平均戒断症状明显更高，且随着时间推移戒断症状减轻幅度更大。最后，两组的副作用数量都很少且没有差异。本研究结果与之前的初步报告一致，即肠胃外注射用丁丙诺啡和口服曲马多方案在急性海洛因戒断管理中使用时，临床差异不大。因此，曲马多作为一种阿片类药物戒断管理药物显示出一定的前景。
