Wilens Timothy, Zulauf Courtney, Ryland Denece, Carrellas Nicholas, Catalina-Wellington Isela
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Bay Cove Human Services, Andrew House Detoxification Center, Quincy, Massachusetts.
Am J Addict. 2015 Mar;24(2):173-177. doi: 10.1111/ajad.12159.
Opioid related morbidity and mortality is heightened in context to the concomitant use of psychotropic medications. The aim of this project was to examine the extent to which opioid dependent patients seeking detoxification are using and misusing specific psychotropic agents.
As part of a quality assurance/improvement project, we systematically assessed prospectively consecutive admissions to a public detoxification program using a self-report questionnaire to query for specific psychotropic medication use. Patients were asked about having a current prescription, appropriate use, and/or medical misuse (higher doses, using without prescription) of amphetamine salts, clonazepam, clonidine, gabapentin, and pregabalin.
We had data on 196 admissions including 162 patients with opioid dependency. Patients receiving detoxification from opioids compared to alcohol had statistically significant higher rates of medication misuse (30% vs. 0%, respectively; χ(2) = 12.8, p < .0003). Of opioid dependent patients receiving prescription medication, 28% reported using higher amounts of each medication than prescribed. Of opioid patients, 10% self-reported misusing clonidine, 22% gabapentin, 7% pregabalin, 25% clonazepam, 11% amphetamine salts, and 36% any of these medications.
Despite the "nonaddictive nature" of some medications (eg, gabapentin, clonidine), high rates of medication misuse in opioid dependent patients admitted for detoxification was found and appeared similar to rates of misuse among controlled substances such as clonazepam and amphetamine salts. These data suggest that opioid dependent patients should be queried for the appropriate use of prescribed medications and that practitioners need to monitor for medication misuse in opioid dependent patients.
在使用精神药物的情况下，阿片类药物相关的发病率和死亡率会升高。本项目的目的是研究寻求戒毒的阿片类药物依赖患者使用和滥用特定精神药物的程度。
作为质量保证/改进项目的一部分，我们使用自我报告问卷系统地前瞻性评估了连续入住公共戒毒项目的患者，以询问特定精神药物的使用情况。询问患者是否有当前的处方、是否合理使用以及/或者是否存在药物滥用（高剂量、无处方使用）苯丙胺盐、氯硝西泮、可乐定、加巴喷丁和普瑞巴林的情况。
我们有196例入院患者的数据，其中包括162例阿片类药物依赖患者。与酒精戒断患者相比，接受阿片类药物戒毒的患者药物滥用率在统计学上显著更高（分别为30%和0%；χ² = 12.8，p <.0003）。在接受处方药治疗的阿片类药物依赖患者中，28%报告使用的每种药物剂量均高于处方剂量。在阿片类药物依赖患者中，10%自我报告滥用可乐定，22%滥用加巴喷丁，7%滥用普瑞巴林，25%滥用氯硝西泮，11%滥用苯丙胺盐，36%滥用这些药物中的任何一种。
尽管某些药物（如加巴喷丁、可乐定）具有“非成瘾性”，但在接受戒毒的阿片类药物依赖患者中发现了较高的药物滥用率，且似乎与氯硝西泮和苯丙胺盐等管制药物的滥用率相似。这些数据表明，应该询问阿片类药物依赖患者对处方药的合理使用情况，并且从业者需要监测阿片类药物依赖患者的药物滥用情况。
