Ing Lorenzini Kuntheavy, Wainstein Laura, Spechbach Hervé, Sarasin François, Ramlawi Majd, Desmeules Jules, Piguet Valérie
Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Pharmacol Res Perspect. 2022 Dec;10(6):e01033. doi: 10.1002/prp2.1033.
Opioid use and associated morbidity and mortality have increased in several countries during the past 20 years. We performed a study whose objective was to assess the frequency and causes of opioid-related emergency division (ED) visits in an adult tertiary Swiss University Hospital over 9 weeks in 2018. We primarily assessed opioid-related adverse drug reactions (ADR), secondary overdose, misuse, abuse, and insufficient pain relief. Current opioid use was identified in 1037 (8.3%) of the 12 470 included ED visits. In 64 opioid users, an ADR was identified as a contributing cause of the ED visit, representing 6.2% of opioid users, and 0.5% of the total ED visits. Moreover, we identified an overdose in 16 opioid users, misuse or abuse in 19 opioid users, and compatible withdrawal symptoms in 7 opioid users. After pooling all these events, we conclude that the ED visits could be related to opioid use in 10.2% of opioid users. Finally, in 201 opioid users, insufficient pain relief (pain not responding to the current pharmacological treatment) was identified as a contributing cause of ED visits. In these cases, other factors than simply pharmacological nonresponse may have been involved. In the context of an ever-increasing opioid use to better control chronic pain situations, these results should reinforce emergency network epidemiological surveillance studies at a national level.
在过去20年中，几个国家的阿片类药物使用及其相关的发病率和死亡率有所上升。我们开展了一项研究，目的是评估2018年一所瑞士三级成人大学医院9周内与阿片类药物相关的急诊就诊频率及原因。我们主要评估了与阿片类药物相关的药物不良反应（ADR）、继发性过量用药、误用、滥用以及疼痛缓解不足的情况。在纳入的12470次急诊就诊中，有1037次（8.3%）发现患者当前正在使用阿片类药物。在64名阿片类药物使用者中，ADR被确定为导致急诊就诊的一个原因，占阿片类药物使用者的6.2%，占急诊就诊总数的0.5%。此外，我们发现16名阿片类药物使用者存在过量用药情况，19名存在误用或滥用情况，7名存在符合症状的戒断症状。汇总所有这些情况后，我们得出结论，10.2%的阿片类药物使用者的急诊就诊可能与阿片类药物使用有关。最后，在201名阿片类药物使用者中，疼痛缓解不足（当前药物治疗无法缓解疼痛）被确定为导致急诊就诊的一个原因。在这些案例中，可能涉及除单纯药物无反应之外的其他因素。在为更好地控制慢性疼痛状况而不断增加阿片类药物使用的背景下，这些结果应加强国家层面的急诊网络流行病学监测研究。
