Johns Hopkins Hospital, Department of Pharmacy, USA.
Johns Hopkins University School of Medicine, Department of Medicine, USA.
Drug Alcohol Depend. 2022 Aug 1;237:109541. doi: 10.1016/j.drugalcdep.2022.109541. Epub 2022 Jun 20.
Buprenorphine is a life-saving treatment for opioid use disorder (OUD). Low-dose initiation (LDI) is an emerging buprenorphine initiation strategy that circumvents barriers associated with standard initiation. This study aims to describe tolerability and completion of LDI using intravenous (IV) buprenorphine and to define dosing protocols in a cohort of patients hospitalized in an urban academic hospital.
Data was collected via retrospective chart review for IV buprenorphine LDI cases initiated between September 1, 2020 and February 28, 2021. Cases were excluded if diagnostic criteria for OUD was not met, Clinical Opiate Withdrawal Scale (COWS) scores were not recorded, or sublingual (SL) buprenorphine was given within 24 h before IV buprenorphine. Completion of LDI and COWS data were assessed for all cases. Cases were categorized based on adherence to a dosing strategy and LDI indication, including OUD and acute pain, non-prescribed fentanyl exposure, and transition from methadone.
Seventy-two cases were identified, and thirteen cases were excluded, leaving 59 cases in the population. Of these cases, 72.9% (43/59) tolerated LDI, and 91.5% (54/59) completed buprenorphine initiation. Forty-four (44/59, 75%) cases were adherent. Median duration of LDI within the adherent group was 23.7 h (IQR 22.8-27.0), 37.1 h (IQR 36.2-40.9), and 48.8 h (IQR 47.0-52.4) for the "rapid," "moderate," and "slow" dosing strategies, respectively.
IV buprenorphine LDI was tolerated and completed in a majority of patients. Dosing protocols allowed for rapid transition to sublingual buprenorphine. Acute pain or recent methadone or fentanyl exposure may inform IV LDI dosing strategy selection.
丁丙诺啡是治疗阿片类药物使用障碍（OUD）的救命疗法。低剂量起始（LDI）是一种新兴的丁丙诺啡起始策略，它规避了与标准起始相关的障碍。本研究旨在描述静脉内（IV）丁丙诺啡 LDI 的耐受性和完成情况，并确定在一家城市学术医院住院的患者队列中的剂量方案。
通过回顾性图表审查收集 2020 年 9 月 1 日至 2021 年 2 月 28 日期间开始的 IV 丁丙诺啡 LDI 病例的数据。如果不符合 OUD 的诊断标准、未记录临床阿片类戒断量表（COWS）评分，或在给予 IV 丁丙诺啡前 24 小时内给予舌下（SL）丁丙诺啡，则排除病例。评估所有病例的 LDI 和 COWS 数据完成情况。根据依从性和 LDI 适应症对病例进行分类，包括 OUD 和急性疼痛、非处方芬太尼暴露以及从美沙酮过渡。
确定了 72 例病例，排除了 13 例病例，在人群中留下 59 例病例。这些病例中，72.9%（43/59）耐受 LDI，91.5%（54/59）完成了丁丙诺啡起始。44 例（44/59，75%）病例是依从的。依从组 LDI 的中位持续时间分别为 23.7 小时（IQR 22.8-27.0）、37.1 小时（IQR 36.2-40.9）和 48.8 小时（IQR 47.0-52.4），适用于“快速”、“中度”和“缓慢”剂量策略。
IV 丁丙诺啡 LDI 在大多数患者中耐受且完成。剂量方案允许快速过渡到舌下丁丙诺啡。急性疼痛或近期美沙酮或芬太尼暴露可能会影响 IV LDI 剂量策略的选择。
