Kinasz Kathryn R, Herbst Ellen D, Kalapatapu Raj K
Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., RTP- Box 0984, San Francisco, CA 94143, USA.
San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
Mil Med. 2020 Sep 18;185(9-10):e1872-e1875. doi: 10.1093/milmed/usaa068.
Buprenorphine induction can lead to precipitated opioid withdrawal, even when using novel techniques such as transdermal buprenorphine. Involuntary limb movements are a distressing symptom of precipitated withdrawal that can be difficult to treat. We report a case of a military veteran transitioning from methadone to buprenorphine for the treatment of opioid use disorder (OUD) using small doses of transdermal buprenorphine. Herein, we review the literature associated with opioid withdrawal-related restlessness. Despite the known risk of concurrent benzodiazepine and buprenorphine administration, including decreased respiratory rate and death, we present a clinical presentation in which this medication combination may be necessary while under medical supervision. We suggest a stepwise algorithm for pharmacotherapy in patients experiencing involuntary limb movements associated with precipitated withdrawal. To safeguard the success of medication-assisted treatment (MAT) for opioid addiction, clinicians should be aware of potential clinical challenges when managing precipitated opioid withdrawal in patients with complex psychiatric comorbidities.
丁丙诺啡诱导可能导致阿片类药物戒断反应提前出现，即使使用诸如透皮丁丙诺啡等新技术也不例外。不自主肢体运动是戒断反应提前出现时令人痛苦的症状，且可能难以治疗。我们报告了一例退伍军人从美沙酮转换为丁丙诺啡以治疗阿片类物质使用障碍（OUD）的病例，该患者使用了小剂量的透皮丁丙诺啡。在此，我们回顾了与阿片类药物戒断相关的烦躁不安的文献。尽管已知同时使用苯二氮䓬类药物和丁丙诺啡存在风险，包括呼吸频率降低和死亡，但我们展示了一种临床情况，即在医疗监督下这种药物组合可能是必要的。我们针对与戒断反应提前出现相关的不自主肢体运动患者，提出了一种逐步的药物治疗算法。为确保阿片类药物成瘾的药物辅助治疗（MAT）取得成功，临床医生在处理合并复杂精神疾病的患者出现的阿片类药物戒断反应提前出现时，应意识到潜在的临床挑战。
