Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA; Ashley Addiction Treatment, Havre de Grace, MD, 21078, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA; Ashley Addiction Treatment, Havre de Grace, MD, 21078, USA.
Drug Alcohol Depend. 2020 Sep 1;214:108147. doi: 10.1016/j.drugalcdep.2020.108147. Epub 2020 Jul 2.
The illicit opioid supply in the U.S. is increasingly adulterated with fentanyl. As such, persons with opioid use disorder (OUD) may be regularly exposed to fentanyl, however, the pharmacokinetics of repeated fentanyl exposure are not well understood. The current study aimed to quantify renal clearance of fentanyl in OUD patients presenting to residential treatment.
Participants (N = 12) who presented to a 28-day residential treatment program were enrolled if they tested positive for fentanyl at intake. Urine samples were collected every 2-3 days and were quantitatively tested for fentanyl, norfentanyl, and creatinine via liquid chromatography mass spectrometry (LC-MS). Fentanyl clearance was defined as the time since last illicit opioid use and the median time between last positive and first negative fentanyl urine screen.
Participants had a mean and standard deviation (SD) age of 28.9 (11.0), were 67 % male, and 83 % white. The mean (SD) time for fentanyl and norfentanyl clearance was 7.3 (4.9) and 13.3 (6.9) days, respectively. One participant continued to test positive for fentanyl for 19 days and norfentanyl for 26 days following their last use, and left treatment without testing negative for norfentanyl.
Fentanyl clearance in persons with OUD is considerably longer than the typical 2-4 day clearance of other short-acting opioids. The findings of this study might explain recent reports of difficulty in buprenorphine inductions for persons who use fentanyl, and point to a need to better understand the pharmacokinetics of fentanyl in the context of opioid withdrawal in persons who regularly use fentanyl.
美国的非法阿片供应越来越多地被芬太尼所掺假。因此，阿片类药物使用障碍（OUD）患者可能经常接触芬太尼，但重复接触芬太尼的药代动力学尚未得到很好的理解。本研究旨在量化接受住院治疗的 OUD 患者体内芬太尼的肾清除率。
如果患者在入院时芬太尼检测呈阳性，则招募参加为期 28 天住院治疗计划的参与者。每隔 2-3 天收集一次尿液样本，并通过液相色谱-质谱（LC-MS）对尿液中的芬太尼、去甲芬太尼和肌酐进行定量检测。芬太尼清除率定义为最后一次非法阿片使用后时间和最后一次阳性到第一次阴性芬太尼尿液筛查之间的中位数时间。
参与者的平均年龄（标准差）为 28.9（11.0）岁，67%为男性，83%为白人。芬太尼和去甲芬太尼的清除中位时间分别为 7.3（4.9）和 13.3（6.9）天。一名参与者在最后一次使用后 19 天内仍持续检测到芬太尼阳性，26 天内仍检测到去甲芬太尼阳性，随后离开治疗而未检测到去甲芬太尼阴性。
OUD 患者的芬太尼清除时间明显长于其他短效阿片类药物的典型 2-4 天清除时间。本研究的结果可能解释了最近报告的使用芬太尼的人在接受丁丙诺啡诱导时遇到的困难，并指出需要更好地了解芬太尼在经常使用芬太尼的人戒断阿片类药物时的药代动力学。
