Gripshover Jeanne, Kosten Thomas
Family Medicine, Florence Medical Group, Florence, USA.
Epidemiology and Behavioral Science, Baylor College of Medicine, Houston, USA.
Cureus. 2022 Aug 3;14(8):e27639. doi: 10.7759/cureus.27639. eCollection 2022 Aug.
Background There is a need for improved strategies for managing abrupt opioid withdrawal when transitioning patients with opioid use disorder to comprehensive longitudinal care strategies such as naltrexone maintenance treatment. In addition, alpha-2 adrenergic agonists are used to ameliorate withdrawal symptoms, but current data characterizing real-world treatment are lacking. Methods A retrospective chart review was conducted in outpatients undergoing abrupt opioid withdrawal managed with lofexidine (0.18 mg, 1-4 tablets 4x daily for 7 days, pro re nata [PRN or as needed]) or clonidine (0.2 mg, 1 tablet 3x daily for 10 days, PRN). Withdrawal outcomes were characterized at 30 days of follow-up. Binomial logistic regression was used to assess a potential association of the two treatments with different likelihoods of opioid cessation success in this real-world outpatient practice. Results In cases treated with lofexidine (n=166) and clonidine (n=432), respectively, 40% and 10% were opioid-free, 6% and 2% continued long-term buprenorphine or methadone, 17% and 36% relapsed, and 37% and 52% were lost to follow-up at 30 days post-withdrawal. Among patients returning for follow-up care, 63% of patients treated with lofexidine and 21% treated with clonidine were opioid-free. Lofexidine was associated with a higher likelihood of opioid cessation success relative to clonidine (OR=6.47; Wald Chi-square=53.79, p<0.001). Conclusion Among outpatients returning for follow-up care, nearly two-thirds of those managed with lofexidine reached opioid-free status at 30 days post-withdrawal, which was a higher likelihood than those managed with clonidine, thus allowing their transition to comprehensive care, including naltrexone.
在将阿片类药物使用障碍患者过渡到纳曲酮维持治疗等全面的长期护理策略时，需要改进管理阿片类药物突然戒断的策略。此外，α-2肾上腺素能激动剂用于改善戒断症状，但目前缺乏描述实际治疗情况的数据。方法：对接受洛非西定（0.18毫克，每日4次，每次1 - 4片，共7天，必要时服用）或可乐定（0.2毫克，每日3次，每次1片，共10天，必要时服用）管理的突然阿片类药物戒断的门诊患者进行回顾性病历审查。在随访30天时对戒断结果进行特征描述。在这种实际的门诊实践中，使用二项逻辑回归评估两种治疗方法与阿片类药物戒断成功可能性不同之间的潜在关联。结果：分别接受洛非西定治疗的患者（n = 166）和接受可乐定治疗的患者（n = 432）中，40%和10%的患者无阿片类药物使用，6%和2%的患者继续长期使用丁丙诺啡或美沙酮，17%和36%的患者复发，37%和52%的患者在戒断后30天失访。在返回接受后续护理的患者中，接受洛非西定治疗的患者中有63%无阿片类药物使用，接受可乐定治疗的患者中有21%无阿片类药物使用。与可乐定相比，洛非西定与阿片类药物戒断成功的可能性更高（OR = 6.47；Wald卡方 = 53.79，p < 0.001）。结论：在返回接受后续护理的门诊患者中，接受洛非西定治疗的患者中近三分之二在戒断后30天达到无阿片类药物状态，这一比接受可乐定治疗的患者可能性更高，从而使他们能够过渡到包括纳曲酮在内的全面护理。
