Lynch Kara L, Shapiro Brad J, Coffa Diana, Novak Scott P, Kral Alex H
Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States.
Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, United States; Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States.
Drug Alcohol Depend. 2015 May 1;150:92-7. doi: 10.1016/j.drugalcdep.2015.02.023. Epub 2015 Feb 26.
Concomitant use of opioids and promethazine has been reported in various subpopulations, including methadone maintenance patients, injection drug users, and at-risk teenagers. Promethazine is thought to potentiate the "high" from opioids. However, to date, the prevalence of promethazine use has not been determined among patients prescribed opioids for chronic pain.
Urine samples from 921 patients prescribed opioids for chronic pain were analyzed for promethazine. Demographic data, toxicology results, and opioid prescription information were obtained through medical record abstraction. We assessed the prevalence and factors associated with promethazine use with bivariable and multivariable statistics.
The prevalence of promethazine-positive urine samples among chronic pain patients was 9%. Only 50% of promethazine-positive patients had an active prescription for promethazine. Having benzodiazepine-positive urine with no prescription for a benzodiazepine was statistically associated with promethazine use. Also, having a prescription for methadone for pain or being in methadone maintenance for the treatment of opioid dependence were both statistically associated with promethazine use. Chronic pain patients prescribed only a long-acting opioid were more likely to have promethazine-positive urines than patients prescribed a short-acting opioid.
The study provides compelling evidence of significant promethazine use in chronic pain patients. Promethazine should be considered as a potential drug of abuse that could cause increased morbidity in opioid-using populations.
在包括美沙酮维持治疗患者、注射吸毒者和高危青少年在内的各种亚人群中，已有阿片类药物与异丙嗪联合使用的报道。异丙嗪被认为会增强阿片类药物带来的“快感”。然而，迄今为止，在因慢性疼痛而开具阿片类药物处方的患者中，异丙嗪的使用 prevalence 尚未确定。
对921名因慢性疼痛而开具阿片类药物处方的患者的尿液样本进行异丙嗪分析。通过病历摘要获取人口统计学数据、毒理学结果和阿片类药物处方信息。我们用双变量和多变量统计方法评估了异丙嗪使用的 prevalence 及其相关因素。
慢性疼痛患者中异丙嗪阳性尿液样本的 prevalence 为9%。只有50%的异丙嗪阳性患者有异丙嗪的有效处方。尿液苯二氮䓬类阳性但无苯二氮䓬类药物处方与异丙嗪使用在统计学上相关。此外，开具美沙酮用于止痛或接受美沙酮维持治疗以治疗阿片类药物依赖均与异丙嗪使用在统计学上相关。仅开具长效阿片类药物的慢性疼痛患者比开具短效阿片类药物的患者更有可能出现异丙嗪阳性尿液。
该研究提供了令人信服的证据，表明慢性疼痛患者中存在大量使用异丙嗪的情况。异丙嗪应被视为一种潜在的滥用药物，可能会增加阿片类药物使用人群的发病率。
