Division on Substance Use Disorders, Department of Psychiatry and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA.
Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA.
Addiction. 2023 Apr;118(4):719-726. doi: 10.1111/add.16100. Epub 2022 Dec 13.
Fentanyl is a highly lipophilic mu opioid receptor agonist, increasingly found in heroin and other drug supplies, that is contributing to marked increases in opioid-related overdose and may be complicating treatment of opioid use disorder (OUD). This study aimed to measure the influence of body mass index (BMI) on fentanyl withdrawal and clearance.
DESIGN, SETTING, PARTICIPANTS: This secondary analysis, from a 10-day inpatient study on the safety and efficacy of sublingual dexmedetomidine for opioid withdrawal, includes participants with OUD (n = 150) recruited from three sites in New York, New Jersey and Florida, who were maintained on oral morphine (30 mg four times per day) for 5 days before starting study medication. Most participants (n = 118) tested positive for fentanyl on admission to the inpatient unit.
Urine toxicology and opioid withdrawal symptoms [Clinical Opioid Withdrawal Scale (COWS) and Short Opiate Withdrawal Scale (SOWS)] were assessed daily. The present analysis includes data on opioid withdrawal from days 1-5 of stabilization and urine toxicology data from days 1-10.
Fentanyl status at admission was not significantly associated with COWS or SOWS scores after adjusting for sex, site and polysubstance use. Participants classified as overweight or obese (n = 66) had significantly higher odds of testing positive for fentanyl across days 1-10 [odds ratio (OR) = 1.65; P < 0.01] and higher SOWS maximum scores across morphine stabilization (P < 0.05) compared to those with a healthy BMI (n = 68).
Among inpatients with opioid use disorder, fentanyl status does not appear to be statistically significantly associated with Clinical Opioid Withdrawal Scale and Short Opiate Withdrawal Scale mean and maximum scores. High body mass index status (overweight or obese) appears to be an important predictor of slower fentanyl clearance and higher Short Opiate Withdrawal Scale maximum scores across the inpatient period than lower body mass index status.
芬太尼是一种高度亲脂性μ阿片受体激动剂，在海洛因和其他毒品供应中越来越常见，这导致阿片类药物相关过量用药显著增加，并且可能使阿片类药物使用障碍（OUD）的治疗复杂化。本研究旨在测量体重指数（BMI）对芬太尼戒断和清除的影响。
设计、地点和参与者：这是一项为期 10 天的住院研究的二次分析，该研究评估了舌下给予右美托咪定治疗阿片类药物戒断的安全性和有效性，纳入了来自纽约、新泽西和佛罗里达三个地点的 150 名患有 OUD 的参与者，这些参与者在开始研究药物前 5 天每天口服吗啡（30mg，每天 4 次）。大多数参与者（n=118）在入院时尿液阿片类药物检测呈芬太尼阳性。
每天评估尿液毒物检测和阿片类药物戒断症状[临床阿片类药物戒断量表（COWS）和短期阿片类药物戒断量表（SOWS）]。本分析包括稳定期第 1-5 天的阿片类药物戒断数据和第 1-10 天的尿液毒物检测数据。
调整性别、地点和多物质使用因素后，入院时的芬太尼状况与 COWS 或 SOWS 评分无显著相关性。被归类为超重或肥胖的参与者（n=66）在第 1-10 天检测出芬太尼阳性的可能性显著高于健康 BMI 参与者（n=68）[比值比（OR）=1.65；P<0.01]，并且在吗啡稳定期的 SOWS 最大评分更高（P<0.05）。
在患有阿片类药物使用障碍的住院患者中，芬太尼状况似乎与临床阿片类药物戒断量表和短期阿片类药物戒断量表的平均和最大评分无统计学显著相关性。高体重指数（超重或肥胖）状态似乎是芬太尼清除率较慢和住院期间短期阿片类药物戒断量表最大评分较高的重要预测因素，而低体重指数状态则不是。
