Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK 73117, USA.
Res Social Adm Pharm. 2012 Sep-Oct;8(5):455-63. doi: 10.1016/j.sapharm.2011.12.002. Epub 2012 Jan 4.
Methadone is often prescribed as a taper schedule to prevent/treat opioid abstinence syndrome (OAS) or neonatal abstinence syndrome (NAS).
The objective of this study was to determine the percentage of children discharged home on methadone tapers and to develop, assess, and implement an instrument for measuring the complexity of the methadone regimens.
This study used a descriptive retrospective design to examine patients younger than 18 years from January 1, 2008, to December 31, 2008, administered methadone for prevention/treatment of OAS/NAS and discharged home on a methadone taper. Data collection included demographics and characteristics of methadone regimen. The primary objective was to determine the percentage of children discharged on methadone. Secondary objectives included characterization (ie, number of dosage and interval changes), duration, and complexity of the methadone taper. Descriptive statistics were performed using Stata v10 (StataCorp LP, College Station, TX). Complexity was evaluated using the medication taper complexity score (MTCS) between 4 raters. Reliability of the MTCS was established using interrater correlation analyses of the regimen complexity scores.
Thirty-three patients (41.8%) were discharged on methadone. The median (range) age was 0.42 (0-12) years, with most patients (75.8%) initiated on methadone for prevention of OAS. Thirty-one patients were included for further analysis of medication complexity. The median (range) duration of the home taper was 8 days (2-48), which included a median (range) of 4 (1-11) dose changes and at least 1 (0-2) change in the interval. MTCS ranged from 7 to 42, with the tool demonstrating 95% interrater reliability.
More than one-third of patients were discharged home on methadone. The median taper duration was 8 days and included a median of 5 adjustments in either the dose or interval. The MTCS demonstrated very good interrater reliability to measure wide variability in the complexity of individual tapers. Future studies should determine the construct validity of the MTCS and the applicability of this tool for further research and clinical application.
美沙酮常用于作为减量方案，以预防/治疗阿片类药物戒断综合征（OAS）或新生儿戒断综合征（NAS）。
本研究的目的是确定出院时接受美沙酮减量方案的儿童比例，并开发、评估和实施一种用于测量美沙酮方案复杂性的工具。
本研究采用描述性回顾性设计，对 2008 年 1 月 1 日至 2008 年 12 月 31 日期间接受美沙酮预防/治疗 OAS/NAS 并出院的年龄小于 18 岁的患者进行了检查。数据收集包括人口统计学资料和美沙酮方案特征。主要目的是确定接受美沙酮治疗的儿童比例。次要目标包括描述性统计（即剂量和间隔变化的次数）、持续时间和美沙酮减量的复杂性。采用 Stata v10（StataCorp LP，德克萨斯州学院站）进行统计分析。采用 4 位评估者之间的药物减量复杂性评分（MTCS）来评估复杂性。通过方案复杂性评分的评估者间相关性分析来确定 MTCS 的可靠性。
33 名患者（41.8%）出院时接受美沙酮治疗。中位（范围）年龄为 0.42（0-12）岁，大多数患者（75.8%）接受美沙酮治疗是为了预防 OAS。31 名患者被纳入进一步分析药物复杂性。家庭减量的中位（范围）持续时间为 8 天（2-48），包括中位数（范围）为 4（1-11）次剂量变化和至少 1 次（0-2）间隔变化。MTCS 范围从 7 到 42，该工具具有 95%的评估者间可靠性。
超过三分之一的患者出院时接受美沙酮治疗。中位数减量持续时间为 8 天，包括剂量或间隔的中位数 5 次调整。MTCS 评估者间的可靠性非常好，可测量个体减量方案的复杂性。未来的研究应确定 MTCS 的结构有效性以及该工具在进一步研究和临床应用中的适用性。
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