Section of Hospital Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Section of Pulmonary and Critical Care Medicine, Department of Medicine, Brown University, Providence, RI.
Am J Ther. 2023;30(1):e1-e9. doi: 10.1097/MJT.0000000000001573. Epub 2022 Nov 11.
Emerging evidence suggests low-dose buprenorphine (LDB) induction can expand opportunities for buprenorphine induction in patients who are taking taking methadone, short-acting opioid agonists, or who have anxiety about opioid withdrawal.
How is a rapid LDB protocol using transdermal buprenorphine tolerated in the hospital?
A prospective study of 20 patient encounters (n = 20 patients) with traditional buprenorphine induction before implementation of study protocol (control group) and 37 patient encounters (n = 34 patients) with LDB induction protocol (pilot group). Summary statistics were used to describe demographics, clinical opioid withdrawal scale and pain scores within 24 hours preprotocol and within 24 hours postprotocol initiation, hospital length of stay after protocol initiation, receipt of a buprenorphine prescription at discharge, and prescription activity at 30 days. T test and chi-square tests were used to analyze comparisons. A subset of pilot group patients completed a survey about their experience.
There were no statistically significant differences in pain and clinical opioid withdrawal scale scores between the pilot and control groups. There were 5 instances of precipitated withdrawal in the pilot group. There was no statistically significant difference in mean discharge time after protocol initiation between the pilot and control groups (P = 0.60). Most patients surveyed described a positive experience with LDB induction.
Hospitalization is a critical time to initiate buprenorphine for patients with opioid use disorder. Our data adds to the growing evidence that LDB induction is feasible for patients taking methadone and short-acting opioid agonists, and that a more rapid induction protocol is generally well-tolerated by patients although precipitated withdrawal is a risk. Finally, our rapid induction protocol did not seem to increase hospital length of stay compared with traditional induction.
新出现的证据表明，低剂量丁丙诺啡（LDB）诱导可以为正在服用美沙酮、短效阿片类激动剂或对阿片类戒断感到焦虑的患者提供更多丁丙诺啡诱导的机会。
在医院中，使用透皮丁丙诺啡的快速 LDB 方案的耐受性如何？
在实施研究方案之前，对 20 例患者（n = 20 例患者）进行传统丁丙诺啡诱导（对照组），对 37 例患者（n = 34 例患者）进行 LDB 诱导方案（试验组）。使用描述性统计数据来描述人口统计学、临床阿片类戒断量表和疼痛评分，在方案启动前 24 小时内和方案启动后 24 小时内，方案启动后住院时间，出院时是否收到丁丙诺啡处方，以及 30 天内的处方活动。使用 t 检验和卡方检验分析比较。对试验组的一部分患者进行了关于他们的经验的调查。
在疼痛和临床阿片类戒断量表评分方面，试验组和对照组之间没有统计学上的显著差异。在试验组中有 5 例出现了戒断反应。方案启动后平均出院时间在试验组和对照组之间没有统计学上的显著差异（P = 0.60）。大多数接受调查的患者描述了他们对 LDB 诱导的积极体验。
对于患有阿片类药物使用障碍的患者，住院是开始使用丁丙诺啡的关键时期。我们的数据增加了越来越多的证据，表明 LDB 诱导对于服用美沙酮和短效阿片类激动剂的患者是可行的，并且尽管有戒断反应的风险，但更快速的诱导方案通常可以被患者很好地耐受。最后，与传统诱导相比，我们的快速诱导方案似乎没有增加住院时间。
