British Columbia Centre on Substance Use (BCCSU), Vancouver, Canada (RB, NF, SN); Department of Family Practice, University of British Columbia, Vancouver, Canada (RB, AR); Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada (NF, SN); Department of Medicine, University of Calgary, Foothills Medical Centre - North Tower, NW Calgary, Canada (KC).
J Addict Med. 2021 Apr 1;15(2):163-166. doi: 10.1097/ADM.0000000000000713.
Across North America, there is an unprecedented opioid overdose epidemic. Approximately 15% of individuals with severe opioid use disorder (OUD) do not benefit from opioid agonist therapy (OAT) such as buprenorphine/naloxone or methadone and are considered treatment refractory. Of those who inject, injectable OAT (iOAT), with hydromorphone or diacetylmorphine, offered in community settings has demonstrated improved retention to treatment and decreased nonprescription opioid use. This case series seeks to describe iOAT initiation and titration in a hospital setting for treatment refractory individuals with OUD and examine impacts of iOAT on leaving hospital against medical advice (AMA).
A retrospective chart review of 4 patients initiated on iOAT during hospitalization at St. Paul's Hospital in Vancouver, BC was completed between July 2017 to May 2018. Outcomes of interest included: (1) dose titration schedules of hydromorphone; and (2) reports of leaving hospital AMA; and (3) continuation of iOAT in community postdischarge.
Of the 4 participants, 2 were female and the mean age was 42 years. Despite a history of AMA, all participants stayed until the recommended the discharge after iOAT initiation. The average total doses of intravenous hydromorphone used during titration were: day 1: 100 mg and days 2 to 3: 200 mg. All continued iOAT in the community and one participant was readmitted within 30 days postdischarge.
This case series describes a novel approach to the management of treatment refractory individuals with severe OUD during hospitalization. Prescribing iOAT in acute care settings is feasible and may reduce rates of leaving hospital AMA.
在整个北美，阿片类药物过量的流行前所未有。大约 15%的严重阿片类药物使用障碍（OUD）患者没有从阿片类激动剂治疗（OAT）中获益，如丁丙诺啡/纳洛酮或美沙酮，被认为是治疗抵抗者。在那些注射药物的人中，在社区环境中提供的可注射 OAT（iOAT），如氢吗啡酮或二乙酰吗啡，已证明可以提高对治疗的保留率，并减少非处方阿片类药物的使用。本病例系列旨在描述在医院环境中为 OUD 治疗抵抗者启动和滴定 iOAT，并检查 iOAT 对违反医嘱（AMA）离开医院的影响。
对 2017 年 7 月至 2018 年 5 月期间在不列颠哥伦比亚省温哥华圣保罗医院住院期间接受 iOAT 治疗的 4 名患者进行了回顾性图表审查。感兴趣的结果包括：（1）氢吗啡酮滴定方案；（2）报告 AMA 离开医院的情况；（3）出院后在社区继续 iOAT。
在 4 名参与者中，有 2 名女性，平均年龄为 42 岁。尽管有 AMA 的病史，但所有参与者在开始 iOAT 治疗后都一直待到建议的出院时间。在滴定过程中，静脉注射氢吗啡酮的平均总剂量为：第 1 天：100mg，第 2 至 3 天：200mg。所有患者在社区继续接受 iOAT，其中 1 名患者在出院后 30 天内再次入院。
本病例系列描述了一种在住院期间管理严重 OUD 治疗抵抗者的新方法。在急性护理环境中开具 iOAT 是可行的，可能会降低 AMA 离开医院的比率。
