Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA; New York City Department of Health and Mental Hygiene, New York, NY, USA.
Greater San Antonio Emergency Physicians, San Antonio, TX 78229, USA.
Am J Emerg Med. 2018 Nov;36(11):1951-1956. doi: 10.1016/j.ajem.2018.02.019. Epub 2018 Mar 2.
To assess the efficacy of 10mg intramuscular (IM) methadone in patients with opioid withdrawal syndrome (OWS).
This was a prospective observational, convenience sample of patients presenting to the ED with mild to moderate OWS. Evaluations included the Clinical Opiate Withdrawal Scale (COWS), Withdrawal Symptoms Scale (WSS), Altered Mental Status Scale (AMSS) and a physician assessment of the patient's WSS (MDWSS). After enrollment, 10mg of IM methadone was administered and patients were reassessed at 30min post-methadone administration. The primary outcome was the change in COWS at baseline and after methadone administration. Secondary outcomes were the differences between AMSS, and WSS post-methadone.
Fifty-seven patients had COWS scores recorded at baseline and 30min. Fifty-six had mild to moderate OWS. The COWS improved a mean of 7.6 after methadone administration (P<0.001). The improvement was greater among patients presenting with moderate versus mild withdrawal (mean decrease=-9.1 vs. -5.5, P<0.001). Patients were more likely to self-score themselves as having withdrawal compared to MDs (93.6% vs. 76.6% respectively, P=0.027). Of the 62 patients with baseline and follow-up WSS by self-assessments, 69% improved post-methadone administration. In addition, the AMSS score remained the same or improved among 86% of cases with measurements at baseline and follow-up.
A single IM dose of 10mg methadone in the ED reduces the severity of acute mild to moderate OWS by 30min. Larger prospective, randomized controlled, and blinded studies would be needed to confirm these results.
评估 10mg 肌肉注射（IM）美沙酮治疗阿片类戒断综合征（OWS）患者的疗效。
这是一项前瞻性观察性、方便样本的研究，纳入了急诊科出现轻度至中度 OWS 的患者。评估包括临床阿片戒断量表（COWS）、戒断症状量表（WSS）、精神状态改变量表（AMSS）以及医生对患者 WSS 的评估（MDWSS）。入组后，给予 10mg IM 美沙酮，并在美沙酮给药后 30 分钟进行再次评估。主要结局是 COWS 在基线和美沙酮给药后的变化。次要结局是 AMSS 和 WSS 与美沙酮给药后的差异。
57 例患者的 COWS 评分在基线和 30 分钟时记录。56 例患者为轻至中度 OWS。美沙酮给药后 COWS 平均改善 7.6 分（P<0.001）。与轻度戒断相比，中度戒断患者的改善更为明显（平均降低值=-9.1 比-5.5，P<0.001）。与 MD 相比，患者更倾向于自我评估自己有戒断症状（分别为 93.6%和 76.6%，P=0.027）。在基线和自我评估随访时均有 WSS 的 62 例患者中，69%的患者在美沙酮给药后改善。此外，在基线和随访时有 AMSS 测量值的病例中，86%的病例 AMSS 评分保持不变或改善。
ED 单次 IM 剂量 10mg 美沙酮可在 30 分钟内减轻急性轻度至中度 OWS 的严重程度。需要更大规模的前瞻性、随机对照、双盲研究来证实这些结果。
