1Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego (UC San Diego), 9500 Gilman Drive, MC 0719, La Jolla, CA 92093-0719, USA.
J Anal Toxicol. 2013 Nov-Dec;37(9):636-41. doi: 10.1093/jat/bkt082. Epub 2013 Sep 29.
Patients being treated with buprenorphine usually have a history of opioid dependence and may be predisposed to misuse of drugs. Concurrent drug misuse increases the risk of life-threatening drug interactions. This retrospective data analysis observed which nonprescribed and illicit drugs were most commonly detected in the urine of patients from pain management clinics taking buprenorphine with or without a prescription. GC, LC/MS and LC-MS-MS were used to quantify 20,929 urine specimens. The most prevalent illicit drug used in both the groups (prescribed and nonprescribed buprenorphine) was marijuana, followed by cocaine. The most prevalent nonprescribed medications abused by both the groups were benzodiazepines, followed by oxycodone and hydrocodone. The overall prevalence of illicit and nonprescribed drug use was significantly higher in subjects who used buprenorphine without a prescription versus prescribed use. Of the concurrent use of marijuana and cocaine with buprenorphine, cocaine is most concerning since it decreases exposure to buprenorphine (lower area under the concentration-time curve and maximum concentration). The concurrent use of nonprescribed benzodiazepines with buprenorphine can cause excess sedation leading to respiratory depression and even death. These findings highlight the importance of educating patients about these potential toxicities. Furthermore, pain providers should consider expanding the spectrum of drugs that they monitor in patients under treatment.
接受丁丙诺啡治疗的患者通常有阿片类药物依赖史，并且可能容易滥用药物。同时使用药物会增加危及生命的药物相互作用的风险。本回顾性数据分析观察了接受丁丙诺啡处方或非处方治疗的疼痛管理诊所患者的尿液中最常检测到的非处方和非法药物。GC、LC/MS 和 LC-MS-MS 用于定量分析 20929 份尿液样本。在接受处方和非处方丁丙诺啡治疗的两组患者中，最常见的非法使用药物是大麻，其次是可卡因。两组患者最常滥用的非处方药物是苯二氮䓬类药物，其次是羟考酮和氢可酮。与处方使用相比，未经处方使用丁丙诺啡的患者中非法和非处方药物使用的总体流行率显著更高。在与丁丙诺啡同时使用大麻和可卡因的情况下，由于可卡因会降低丁丙诺啡的暴露量（降低浓度-时间曲线下面积和最大浓度），因此可卡因更令人担忧。与丁丙诺啡同时使用非处方苯二氮䓬类药物会导致过度镇静，从而导致呼吸抑制甚至死亡。这些发现强调了教育患者了解这些潜在毒性的重要性。此外，疼痛提供者应考虑扩大他们监测治疗中患者使用的药物种类。
