Psychiatric Hospital Meiringen, Meiringen.
Department of Psychiatry, Center for Addictive Disorders, Psychotherapy and Psychosomatics, Psychiatric Hospital.
Clin Neuropharmacol. 2020 Sep/Oct;43(5):127-133. doi: 10.1097/WNF.0000000000000403.
Among opioid-dependent patients on maintenance therapy, concomitant drug abuse is a serious problem. Dextromethorphan, an over-the-counter antitussive agent that can be purchased without prescription, is a drug with a high potential for misuse, especially when consumed in high doses.The objective of this study was to investigate possible abuse of dextromethorphan among substituted opioid-dependent patients and comparison of subjective and objective findings.Due to its ability to increase serotonin levels, opioid-dependent patients may be particularly susceptible to dextromethorphan misuse. Dextromethorphan misuse may have side effects, including psychiatric symptoms and serotonin syndrome, and may induce assault, suicide, or homicide.
A total of 104 opioid-dependent patients in maintenance treatment were included in this cross-sectional study conducted in the outpatient department of the Psychiatric Hospital, University of Zurich. Study participants were divided into 2 groups based on laboratory results: dextromethorphan abusers (n = 12) and nonabusers (n = 92). The objective use and concentrations of dextromethorphan was detected using 3-month hair toxicology analysis.Statistical analysis was performed by using χ test, Student t test, Mann-Whitney U test, and Barnard exact test.
Dextromethorphan was abused by 12 (11.5%) patients, 11 (91.7%) of whom did not report concomitant abuse of dextromethorphan but were identified through hair analysis. In general, there were significant differences among patients abusing dextromethorphan compared with nondextromethorphan consumers in terms of trauma due to sexual maltreatment/violence, multiple traumas, or harmful use of hallucinogenic drugs.
Further studies are necessary to examine dextromethorphan and its impact on patients with psychiatric comorbidities and psychiatric medication. According to literature, there is a significant drug interaction risk due to the impact of dextromethorphan misuse on serotonin syndrome and psychiatric symptoms.1-3 We recommend active inquiry into and testing for concomitant drug abuse among substituted opioid-dependent patients to reduce the risk of drug interactions and side effects in this especially vulnerable group of patients.
在接受维持治疗的阿片类药物依赖患者中，同时存在药物滥用是一个严重的问题。右美沙芬是一种非处方镇咳药，无需处方即可购买，具有很高的滥用潜力，尤其是在高剂量使用时。本研究的目的是调查替代阿片类药物依赖患者中右美沙芬的可能滥用情况，并比较主观和客观发现。由于其增加 5-羟色胺水平的能力，阿片类药物依赖患者可能特别容易受到右美沙芬的滥用。右美沙芬滥用可能会产生副作用，包括精神病症状和 5-羟色胺综合征，并可能导致攻击、自杀或杀人。
本研究为一项横断面研究，共纳入 104 名在苏黎世大学精神病院接受维持治疗的阿片类药物依赖患者。根据实验室结果，将研究参与者分为 2 组：右美沙芬滥用组（n = 12）和非滥用组（n = 92）。通过 3 个月的毛发毒理学分析检测右美沙芬的客观使用和浓度。使用 χ2 检验、学生 t 检验、Mann-Whitney U 检验和 Barnard 确切检验进行统计学分析。
12 名（11.5%）患者滥用右美沙芬，其中 11 名（91.7%）患者未报告同时滥用右美沙芬，但通过毛发分析发现。一般来说，与非右美沙芬消费者相比，滥用右美沙芬的患者在性虐待/暴力所致创伤、多重创伤或致幻剂药物的有害使用方面存在显著差异。
需要进一步研究右美沙芬及其对伴有精神共病和精神药物治疗的患者的影响。根据文献，由于右美沙芬滥用对 5-羟色胺综合征和精神症状的影响，存在显著的药物相互作用风险。1-3 我们建议积极询问和测试替代阿片类药物依赖患者同时存在的药物滥用情况，以降低该特别脆弱患者群体发生药物相互作用和副作用的风险。
