Koch Jessa, Ward Sarah, Thomas Christopher J
Assistant Professor, Loma Linda University, Loma Linda, California,
Psychiatric Clinical Pharmacy Specialist, VA Tennessee Valley HS, Chattanooga, Tennessee.
Ment Health Clin. 2018 Mar 23;7(6):282-286. doi: 10.9740/mhc.2017.11.282. eCollection 2017 Nov.
The Chillicothe Veterans Affairs Medical Center serves veterans from southern Ohio, Kentucky, and West Virginia, where the rates of non-medical opioid use are some of the highest in the nation. Prior to this project, there was not a standardized practice for the treatment of veterans undergoing opioid withdrawal at the facility. In May 2015, a symptom-triggered protocol was initiated to improve the quality of care and decrease the length of detoxification for veterans treated at the Chillicothe Veterans Affairs Medical Center.
This paper reflects a 2-phase project that took place from August 2014 through June 2016. Phase 1 focused on the development of a symptom-triggered opioid withdrawal protocol using the Clinical Opiate Withdrawal Scale for assessment and buprenorphine/naloxone or clonidine for treatment. Phase 2 was a retrospective cohort analysis comparing outcomes between group 1, before protocol initiation; group 2, after protocol initiation with clonidine; and group 3, after protocol initiation with buprenorphine/naloxone. The primary outcome assessed was length of detoxification (in days). Secondary outcomes included length of hospitalization (in days) for the index admission, outpatient substance abuse treatment program participation rates, and opioid sobriety rates at 3 months after detoxification.
A statistically significant reduction in the duration of detoxification days was detected after protocol initiation in veterans who received buprenorphine/naloxone or clonidine in accordance with the protocol.
This retrospective quality analysis supports the use of a symptom-triggered opioid withdrawal protocol using the Clinical Opiate Withdrawal Scale for assessment and clonidine or buprenorphine/naloxone for detoxification treatment.
奇利科西退伍军人事务医疗中心为俄亥俄州南部、肯塔基州和西弗吉尼亚州的退伍军人提供服务，这些地区的非医疗性阿片类药物使用率在全国名列前茅。在该项目开展之前，该机构在治疗阿片类药物戒断退伍军人方面没有标准化的做法。2015年5月，启动了一项症状触发方案，以提高护理质量并缩短在奇利科西退伍军人事务医疗中心接受治疗的退伍军人的戒毒时间。
本文反映了一个从2014年8月至2016年6月的两阶段项目。第一阶段重点是制定一种症状触发的阿片类药物戒断方案，使用临床阿片类药物戒断量表进行评估，并使用丁丙诺啡/纳洛酮或可乐定进行治疗。第二阶段是一项回顾性队列分析，比较第1组（方案启动前）、第2组（方案启动后使用可乐定）和第3组（方案启动后使用丁丙诺啡/纳洛酮）之间的结果。评估的主要结果是戒毒时间（以天为单位）。次要结果包括首次入院的住院时间（以天为单位）、门诊药物滥用治疗项目参与率以及戒毒后3个月的阿片类药物戒断率。
在按照方案接受丁丙诺啡/纳洛酮或可乐定治疗的退伍军人中，方案启动后戒毒天数有统计学意义的显著减少。
这项回顾性质量分析支持使用一种症状触发的阿片类药物戒断方案，该方案使用临床阿片类药物戒断量表进行评估，并使用可乐定或丁丙诺啡/纳洛酮进行戒毒治疗。
