Cook County Health, Department of Emergency Medicine, Division of Medical Toxicology, 1950 West Polk Street, 7th floor, cubicle 85, Chicago, IL 60612, United States.
Cook County Health, Department of Emergency Medicine, Division of Medical Toxicology, Chicago, IL, United States.
Am J Emerg Med. 2020 Mar;38(3):691.e3-691.e4. doi: 10.1016/j.ajem.2019.09.014. Epub 2019 Nov 16.
Naloxone is a frequently utilized and effective treatment to reverse the life-threatening effects of illicit opioid intoxication. Excessive naloxone dosing in these circumstances, however, may lead to naloxone-precipitated opioid withdrawal in individuals with opioid dependence. Buprenorphine, a partial mu-opioid agonist, is increasingly utilized in the Emergency Department (ED) for the treatment of opioid withdrawal syndrome but little is known regarding its utility in cases of naloxone-precipitated opioid withdrawal. We report a case of naloxone-precipitated opioid withdrawal that was effectively treated with sublingual buprenorphine. An older male was brought into the ED with signs and symptoms of opioid toxicity that was successfully treated with pre-hospital naloxone by Emergency Medical Services. He had a clinical opioid withdrawal scale (COWS) or 10 with abdominal cramping and unintentional defecation. After a discussion of treatment options and possible adverse effects with the patient, the decision was made to administer 4 mg/1 mg of sublingual buprenorphine/naloxone film. The patient reported a rapid improvement in symptoms and at 30 min posttreatment, his COWS was 4. His COWS decreased to 3 at 1 h and this was sustained for 4 h of observation. The patient was subsequently discharged to a treatment facility for opioid use disorder. This case highlights the potential of buprenorphine as a treatment modality for acute naloxone-precipitated opioid withdrawal. Due to the risks of worsening or sustained buprenorphine-precipitated opioid withdrawal, further research is warranted to identify patients who may benefit from this therapy.
纳洛酮是一种常用于逆转非法阿片类药物中毒导致生命威胁的有效治疗方法。然而，在这些情况下过量使用纳洛酮可能导致有阿片类药物依赖的个体出现纳洛酮诱发的阿片类药物戒断。丁丙诺啡是一种部分μ-阿片受体激动剂，在急诊科越来越多地用于治疗阿片类药物戒断综合征，但对于其在纳洛酮诱发的阿片类药物戒断中的应用知之甚少。我们报告了一例纳洛酮诱发的阿片类药物戒断病例，该病例经舌下丁丙诺啡治疗有效。一名老年男性因阿片类药物中毒的迹象和症状被送入急诊科，经急诊医疗服务中心院前给予纳洛酮成功治疗。他的临床阿片类药物戒断量表（COWS）评分为 10 分，伴有腹痛和非自愿性排便。在与患者讨论了治疗方案和可能的不良反应后，决定给予 4mg/1mg 的舌下丁丙诺啡/纳洛酮膜。患者报告症状迅速改善，治疗后 30 分钟 COWS 评分为 4。1 小时后 COWS 降至 3，并持续观察 4 小时。随后，患者被送往治疗阿片类药物使用障碍的机构。该病例突出了丁丙诺啡作为急性纳洛酮诱发的阿片类药物戒断治疗方法的潜力。由于丁丙诺啡诱发的阿片类药物戒断恶化或持续的风险，需要进一步研究以确定可能受益于这种治疗的患者。
