Dunn Kelly E, Saulsgiver Kathryn A, Miller Mollie E, Nuzzo Paul A, Sigmon Stacey C
Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States.
University of Pennsylvania School of Medicine, Philadelphia, PA, United States.
Drug Alcohol Depend. 2015 Jun 1;151:47-55. doi: 10.1016/j.drugalcdep.2015.02.033. Epub 2015 Mar 12.
Prescription opioid (PO) abuse has become an urgent public health issue in the United States. Detoxification is one important treatment option, yet relatively little is known about the time course and severity of opioid withdrawal during buprenorphine detoxification.
This is a secondary analysis of data from a randomized, placebo-controlled, double-blind evaluation of 1, 2, and 4-week outpatient buprenorphine tapers among primary prescription opioid (PO) abusers. The aim is to characterize the time course and severity of buprenorphine withdrawal under rigorous, double-blind conditions, across multiple taper durations, and using multiple withdrawal-related measures (i.e., self-report and observer ratings, pupil diameter, ancillary medication utilization). Participants were PO-dependent adults undergoing buprenorphine detoxification and biochemically-verified to be continuously abstinent from opioids during their taper (N = 28).
Participants randomly assigned to the 4-week taper regimen experienced a relatively mild and stable course of withdrawal, with few peaks in severity. In contrast, the 1- and 2-week taper groups experienced stark increases in withdrawal severity during the week following the last buprenorphine dose, followed by declines in withdrawal severity thereafter. The 4-week taper group also reported significantly fewer disruptions in sleep compared to the other experimental groups. When predictors of withdrawal were examined, baseline ratings of "Expected Withdrawal Severity" was the most robust predictor of withdrawal experienced during the taper.
Data from this trial may inform clinicians about the expected time course, magnitude, and pattern of buprenorphine withdrawal and aid efforts to identify patients who may need additional clinical support during outpatient buprenorphine detoxification.
处方阿片类药物滥用已成为美国一个紧迫的公共卫生问题。脱毒是一种重要的治疗选择，但对于丁丙诺啡脱毒期间阿片类药物戒断的时间进程和严重程度，人们了解相对较少。
这是一项对数据的二次分析，该数据来自一项针对原发性处方阿片类药物滥用者进行的1周、2周和4周门诊丁丙诺啡逐渐减量的随机、安慰剂对照、双盲评估。目的是在严格的双盲条件下，跨越多个逐渐减量持续时间，并使用多种与戒断相关的测量方法（即自我报告和观察者评分、瞳孔直径、辅助药物使用情况）来描述丁丙诺啡戒断的时间进程和严重程度。参与者为正在接受丁丙诺啡脱毒的阿片类药物依赖成年人，并且在逐渐减量期间经生化验证持续戒除阿片类药物（N = 28）。
随机分配到4周逐渐减量方案的参与者经历了相对温和且稳定的戒断过程，严重程度几乎没有峰值。相比之下，1周和2周逐渐减量组在最后一剂丁丙诺啡后的一周内戒断严重程度急剧增加，此后戒断严重程度下降。与其他实验组相比，4周逐渐减量组报告的睡眠干扰也明显更少。在检查戒断的预测因素时，“预期戒断严重程度”的基线评分是逐渐减量期间经历的戒断的最有力预测因素。
该试验的数据可为临床医生提供有关丁丙诺啡戒断的预期时间进程、程度和模式的信息，并有助于识别在门诊丁丙诺啡脱毒期间可能需要额外临床支持的患者。
