Chai Peter R, Carreiro Stephanie, Innes Brendan J, Chapman Brittany, Schreiber Kristin L, Edwards Robert R, Carrico Adam W, Boyer Edward W
From the Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
Anesth Analg. 2017 Dec;125(6):2105-2112. doi: 10.1213/ANE.0000000000002574.
Opioid analgesics are commonly prescribed on an as-needed (PRN) basis for acute painful conditions. Uncertainty of how patients actually take PRN opioids, coupled with a desire to completely cover pain, leads to variable and overly generous opioid prescribing practices, resulting in a surplus of opioids. This opioid surplus becomes a source for diversion and nonmedical opioid use. Understanding patterns of actual opioid ingestion after acute painful conditions can help clinicians counsel patients on safe opioid use, and allow timely recognition and intervention when escalating opioid self-dosing occurs, to prevent tolerance and addiction.
We used a novel oxycodone digital pill system (ingestible biosensor within a standard gelatin capsule combined with 5-mg oxycodone) that when ingested, is activated by the chloride ion gradient in the stomach thereby emitting a radiofrequency signal captured by a wearable reader. The reader relays ingestion data to a cloud-based server that displays ingestion events to the study team. We deployed the oxycodone digital pill among opioid-naive individuals discharged from the emergency department with acute fracture pain. Participants were trained on digital pill operation and discharged with twenty-one 5-mg oxycodone digital pills. They were instructed to take digital pills PRN for pain on discharge. We conducted a brief interview 7 days after study enrollment, at which point participants returned the digital pill system. We identified oxycodone ingestion events in real time by data from the digital pill system and performed pill counts at the return visit to validate digital pill reporting of medication ingestion.
In this study, 26 individuals were approached; 16 enrolled with 15 completing the study. Participants ingested a median of 6 (3-9.5) oxycodone digital pills over the course of 7 days, with 82% of the oxycodone dose ingested in the first 3 days. In individuals who required operative repair, 86% (N = 6) continued to ingest opioids at 1 week. There was substantial variability in ingestion patterns between individuals.
The utilization patterns of individuals with acute fracture pain could be captured using a digital pill system and revealed a median opioid ingestion of 45-mg morphine equivalents for acute pain over 7 days. Seven participants ceased using opioids within 4 days after discharge from the emergency department, although operative repair was associated with longer use. This digital pill system was able to measure changes in and patterns of opioid self-dosing, which varied between patients.
阿片类镇痛药通常根据需要（PRN）用于急性疼痛状况。患者实际服用按需给药阿片类药物的不确定性，再加上想要完全控制疼痛的愿望，导致阿片类药物的处方做法多变且过于宽松，从而造成阿片类药物过剩。这种阿片类药物过剩成为药物转移和非医疗性阿片类药物使用的源头。了解急性疼痛状况后实际阿片类药物摄入模式有助于临床医生指导患者安全使用阿片类药物，并在阿片类药物自我给药剂量增加时及时识别并进行干预，以预防耐受性和成瘾。
我们使用了一种新型羟考酮数字药丸系统（标准明胶胶囊内的可摄入生物传感器与5毫克羟考酮结合），该系统摄入后会被胃中的氯离子梯度激活，从而发出可被可穿戴读取器捕获的射频信号。读取器将摄入数据传输到基于云的服务器，该服务器会向研究团队显示摄入事件。我们在因急性骨折疼痛从急诊科出院的未使用过阿片类药物的个体中部署了羟考酮数字药丸。参与者接受了数字药丸操作培训，并带着21颗5毫克的羟考酮数字药丸出院。他们被指示出院后按需服用数字药丸来止痛。在研究入组7天后我们进行了一次简短访谈，此时参与者归还了数字药丸系统。我们通过数字药丸系统的数据实时识别羟考酮摄入事件，并在回访时进行药丸计数以验证数字药丸对药物摄入的报告。
在本研究中，我们接触了26个人；16人入组，15人完成了研究。参与者在7天内摄入的羟考酮数字药丸中位数为6（3 - 9.5）颗，其中82%的羟考酮剂量是在前3天摄入的。在需要手术修复的个体中，86%（N = 6）在1周时仍在摄入阿片类药物。个体之间的摄入模式存在很大差异。
使用数字药丸系统可以捕捉急性骨折疼痛个体的用药模式，结果显示急性疼痛在7天内阿片类药物摄入的中位数为45毫克吗啡当量。7名参与者在从急诊科出院后4天内停止使用阿片类药物，尽管手术修复与更长时间的使用有关。这种数字药丸系统能够测量阿片类药物自我给药的变化和模式，而这些在患者之间各不相同。
