Drug Health Services, Sydney Local Heath District, Australia; Sydney Medical School, Camperdown, 2006 NSW, Australia.
Liverpool Hospital, South Western Sydney Local Heath District, Liverpool, 2170 NSW, Australia.
Drug Alcohol Depend. 2017 Dec 1;181:132-139. doi: 10.1016/j.drugalcdep.2017.09.024. Epub 2017 Oct 13.
Opioid substitution treatment (OST) is often continued long-term and, therefore, opioid-associated symptoms are of interest. Symptoms associated with methadone maintenance treatment (MMT) in men are well described, but there are fewer reports concerning symptoms associated with buprenorphine maintenance treatment (BMT) and very few reports among women.
Recipients of BMT (n=113) and MMT (n=184), non-opioid users (n=105) and opioid users not receiving OST (n=87) completed the Patient Assessment of Constipation (PAC-SYM) and a general symptom checklist. Multivariate analysis included other potential moderators of opioid-associated symptoms.
Opioid users reported a higher frequency and severity of symptoms than non-opioid users. Constipation, dry mouth, decreased appetite, sweating and fatigue were highly prevalent in the previous 30days (51-80%). Nausea, itchy skin, trouble urinating, menstrual problems, lightheadedness, blurred vision, heart racing were also common (30-50%). Non-OST opioid users had significantly higher frequency and severity than OST recipients of nausea, vomiting, diarrhoea, decreased appetite, sweating and itchy skin. Sweating was significantly more common in MMT than BMT. Constipation scores were higher in women, otherwise most sex differences were small. Higher PAC-SYM scores were associated with vomiting (OR=1.04) and sweating (OR=1.06). Cannabis use was associated with vomiting (OR=2.19). Constipation (OR=1.07), insomnia (OR=2.5) and depression (OR=2.82) were associated with fatigue.
Men and women receiving OST report similarly high rates of somatic symptoms, though less than opioid users not receiving OST. There were few differences between BMT and MMT. Buprenorphine might be preferred where sweating is problematic. Several modifiable factors were identified.
阿片类药物替代治疗（OST）通常需要长期进行，因此，阿片类药物相关症状引起了关注。男性接受美沙酮维持治疗（MMT）相关症状已有详细描述，但关于丁丙诺啡维持治疗（BMT）相关症状的报告较少，女性的报告则更少。
接受 BMT（n=113）和 MMT（n=184）的患者、非阿片类药物使用者（n=105）和未接受 OST 的阿片类药物使用者（n=87）完成了患者便秘评估量表（PAC-SYM）和一般症状清单。多变量分析包括其他可能影响阿片类药物相关症状的调节剂。
阿片类药物使用者报告的症状频率和严重程度高于非阿片类药物使用者。便秘、口干、食欲减退、出汗和疲劳在过去 30 天内非常普遍（51-80%）。恶心、皮肤瘙痒、排尿困难、月经问题、头晕、视力模糊、心跳加速也很常见（30-50%）。非 OST 阿片类药物使用者的恶心、呕吐、腹泻、食欲减退、出汗和皮肤瘙痒的频率和严重程度明显高于 OST 接受者。与 BMT 相比，MMT 中出汗更为常见。女性的便秘评分较高，否则大多数性别差异较小。较高的 PAC-SYM 评分与呕吐（OR=1.04）和出汗（OR=1.06）相关。大麻使用与呕吐相关（OR=2.19）。便秘（OR=1.07）、失眠（OR=2.5）和抑郁（OR=2.82）与疲劳相关。
接受 OST 的男性和女性报告的躯体症状发生率同样较高，尽管低于未接受 OST 的阿片类药物使用者。BMT 和 MMT 之间几乎没有差异。如果出汗问题严重，可能会选择丁丙诺啡。确定了几个可修改的因素。
