a Department of Emergency Medicine , Hennepin County Medical Center , Minneapolis , MN , USA.
b Minnesota Poison Control System , Minneapolis , MN , USA.
Clin Toxicol (Phila). 2019 Aug;57(8):697-702. doi: 10.1080/15563650.2018.1547828. Epub 2019 Feb 4.
Patients with opioid withdrawal often present to the Emergency Department (ED), but many EDs do not have the infrastructure in place to initiate treatment with opioid agonists (methadone or buprenorphine). Therefore, ED management often entails symptomatic control. The purpose of this study was to compare olanzapine to clonidine for the treatment of opioid withdrawal symptoms. This was a prospective, randomized clinical trial comparing 10 mg of IM olanzapine to 0.3 mg of oral clonidine for symptoms of opioid withdrawal. Adult (18 years and older) ED patients reporting a history of opioid use and symptoms consistent with withdrawal were eligible. Patients were excluded if they had already received treatment during the ED encounter, were pregnant, incarcerated, or unable to provide consent. Patients were randomized 1:1 to receive olanzapine or clonidine for their initial treatment. A baseline Clinical Opiate Withdrawal Scale (COWS) score was calculated. After 30 min, the patient could receive any additional treatment at the ED physician's discretion. The primary outcome was need for additional medication (rescue) within 1 h of study medication administration. Secondary outcomes included change in COWS score and adverse reactions. We enrolled 63 patients (33 olanzapine, 30 clonidine). Demographic characteristics were similar for both groups (median age 45, range 21-67, 54% male) as well as baseline COWS score (median score 11). The median time since last opiate use was 48 h for both groups (range 4-116). Rescue was given within 1 h for olanzapine for 9 (27%) patients and for clonidine in 19 (63%) patients (difference 36%, 95% CI 13-59%). Decrease in COWS score at 1 h was 8.3 for olanzapine and 5.1 for clonidine (difference 3.2, 95% CI 0.3-6). Adverse events were uncommon: akathisia (1, olanzapine), hypotension (2, clonidine), respiratory depression (0). Treatment of opioid withdrawal symptoms with 10 mg of IM olanzapine results in a lower incidence of rescue medication administration and improved symptoms (COWS score) compared to 0.3 mg of oral clonidine.
患有阿片类药物戒断的患者经常到急诊部（ED）就诊，但许多 ED 没有基础设施来启动阿片类药物激动剂（美沙酮或丁丙诺啡）治疗。因此，ED 管理通常需要对症治疗。本研究的目的是比较奥氮平与可乐定治疗阿片类药物戒断症状。 这是一项前瞻性、随机临床试验，比较了 IM 奥氮平 10mg 与口服可乐定 0.3mg 治疗阿片类药物戒断症状。报告有阿片类药物使用史且症状符合戒断的成年（18 岁及以上）ED 患者有资格参加。如果患者在 ED 就诊期间已接受治疗、怀孕、被监禁或无法提供同意，则将其排除在外。患者以 1:1 的比例随机接受奥氮平或可乐定作为初始治疗。计算基线临床阿片类戒断量表（COWS）评分。30 分钟后，根据 ED 医生的判断，患者可以接受任何额外的治疗。主要结局是在研究药物给药后 1 小时内需要额外药物（抢救）。次要结局包括 COWS 评分的变化和不良反应。 我们共纳入 63 名患者（奥氮平 33 名，可乐定 30 名）。两组的人口统计学特征相似（中位年龄 45 岁，范围 21-67 岁，54%为男性），以及基线 COWS 评分（中位数为 11）。两组的中位末次阿片类药物使用时间均为 48 小时（范围 4-116 小时）。奥氮平组在 1 小时内需要抢救的患者有 9 人（27%），可乐定组为 19 人（63%）（差异 36%，95%CI 13-59%）。奥氮平组在 1 小时时 COWS 评分下降 8.3，可乐定组下降 5.1（差异 3.2，95%CI 0.3-6）。不良反应少见：静坐不能（1 例，奥氮平）、低血压（2 例，可乐定）、呼吸抑制（0 例）。 与 0.3mg 口服可乐定相比，IM 奥氮平 10mg 治疗阿片类药物戒断症状可降低抢救药物的使用发生率并改善症状（COWS 评分）。
