Hopper John A, Wu Joanna, Martus Wesley, Pierre James D
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
J Opioid Manag. 2005 Mar-Apr;1(1):31-5. doi: 10.5055/jom.2005.0009.
Detoxification from opioids remains an important first step in the treatment of many patients with opioid dependence. Several pharmacologic regimens have been used for opioid detoxification. In the United States, the partial mu-opioid agonist, buprenorphine (BUP) is the most recently approved pharmacotherapy for opioid detoxification and replacement. The literature in recent years has described detoxification protocols using a single high dose of BUP and a three-day BUP regimen. In many settings, such as drug-free programs, a single-dose detoxification protocol would be of significant benefit. There have been no prior studies comparing one-day and three-day BUP-assisted opioid withdrawal. In this pilot study, we conducted an open-label, randomized trial of one-day vs. three-day BUP/naloxone sublingual tablet-assisted opioid withdrawal. Twenty patients from a therapeutic community treatment program were randomly assigned to receive either 32 mg sublingual BUP over one hour (one-day group), or 32 mg sublingual BUP over three days (three-day group). Nine of 10 subjects (90 percent) in each group completed seven days in the detoxification protocol. There was no statistically significant difference between the two groups in all other outcome variables, including retention in the treatment program, intensity of withdrawal signs and symptoms, amounts of adjunct medications used, and ability to produce opiate-free urine. This study further validates the feasibility of the single high dose of BUP as a rapid detoxification method.
阿片类药物脱毒仍然是许多阿片类药物依赖患者治疗的重要第一步。几种药物治疗方案已用于阿片类药物脱毒。在美国，部分μ-阿片受体激动剂丁丙诺啡（BUP）是最近批准用于阿片类药物脱毒和替代的药物疗法。近年来的文献描述了使用单次高剂量BUP和为期三天的BUP方案的脱毒方案。在许多情况下，如无毒品计划，单剂量脱毒方案将有显著益处。此前没有比较一日和三日BUP辅助阿片类药物戒断的研究。在这项试点研究中，我们进行了一项开放标签、随机试验，比较一日与三日BUP/纳洛酮舌下片辅助阿片类药物戒断的效果。来自一个治疗社区治疗项目的20名患者被随机分配接受1小时内舌下含服32mg BUP（一日组）或三天内舌下含服32mg BUP（三日组）。每组10名受试者中有9名（90%）完成了七天的脱毒方案。在所有其他结局变量方面，包括治疗项目中的留存率、戒断体征和症状的强度、辅助药物的使用量以及产生无阿片类药物尿液的能力，两组之间没有统计学上的显著差异。这项研究进一步验证了单次高剂量BUP作为一种快速脱毒方法的可行性。
