Lee Samantha, Klein-Schwartz Wendy, Welsh Christopher, Doyon Suzanne
University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
J Emerg Med. 2013 Aug;45(2):199-205. doi: 10.1016/j.jemermed.2012.11.104. Epub 2013 May 11.
There exists a significant amount of misinformation regarding methadone and buprenorphine, and a belief that toxicity associated with nonmedical use of methadone and nonmedical use of buprenorphine is similar in severity and outcomes.
The objective of this study is to compare outcomes associated with nonmedical use of methadone vs. nonmedical use of buprenorphine in patients presenting to the Emergency Department (ED) and reported to poison centers.
This was a retrospective cohort study using data from the American Association of Poison Control Centers from January 1, 2003 to December 31, 2009 (7 years). Inclusion criteria were nonmedical use of methadone or buprenorphine (or buprenorphine/naloxone) as a single substance by history, age 18 years or older, ingestions only, evaluated in an ED. Outcome measures were clinical effects, treatments, disposition, and final medical outcomes.
Of 1,920 cases, 1,594 were in the methadone group and 326 were in the buprenorphine group. Frequently reported clinical effects were lethargy, 59.2% vs. 29.4%, and respiratory depression, 28.7% vs. 2.5%, for methadone and buprenorphine groups, respectively. Hospitalization rates were 67.4% in the methadone group and 32.2% in the buprenorphine group. Half of all patients in the methadone group were admitted to the intensive care unit (ICU) vs. only 15% of all the patients in the buprenorphine group. Twenty-six patients in the methadone group died vs. no deaths in the buprenorphine group. There were significant differences in the distribution of clinical effects, disposition, and medical outcomes (p < 0.001).
Patients who use methadone nonmedically have higher hospitalization rates, greater ICU utilization rates, and considerably worse medical outcomes when compared with patients who use buprenorphine nonmedically.
关于美沙酮和丁丙诺啡存在大量错误信息，并且人们认为与非医疗使用美沙酮和非医疗使用丁丙诺啡相关的毒性在严重程度和后果方面相似。
本研究的目的是比较急诊科就诊并向中毒控制中心报告的患者中非医疗使用美沙酮与非医疗使用丁丙诺啡的相关后果。
这是一项回顾性队列研究，使用了美国中毒控制中心协会2003年1月1日至2009年12月31日（7年）的数据。纳入标准为根据病史非医疗使用美沙酮或丁丙诺啡（或丁丙诺啡/纳洛酮）作为单一物质、年龄18岁及以上、仅为摄入、在急诊科接受评估。结局指标为临床效应、治疗、处置和最终医疗结局。
在1920例病例中，美沙酮组有1594例，丁丙诺啡组有326例。美沙酮组和丁丙诺啡组经常报告的临床效应分别为嗜睡（59.2%对29.4%）和呼吸抑制（28.7%对2.5%）。美沙酮组的住院率为67.4%，丁丙诺啡组为32.2%。美沙酮组所有患者中有一半被收入重症监护病房（ICU），而丁丙诺啡组所有患者中只有15%。美沙酮组有26例患者死亡，丁丙诺啡组无死亡病例。临床效应、处置和医疗结局的分布存在显著差异（p<0.001）。
与非医疗使用丁丙诺啡的患者相比，非医疗使用美沙酮的患者住院率更高、ICU利用率更高且医疗结局明显更差。
