Dunn Kelly E, Bird H Elizabeth, Bergeria Cecilia L, Ware Orrin D, Strain Eric C, Huhn Andrew S
Johns Hopkins University School of Medicine, Baltimore, MD, United States.
University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, United States.
Front Psychiatry. 2023 Apr 20;14:1141980. doi: 10.3389/fpsyt.2023.1141980. eCollection 2023.
Opioid withdrawal can be expressed as both a spontaneous and precipitated syndrome. Although spontaneous withdrawal is well-characterized, there is no operational definition of precipitated opioid withdrawal.
People ( = 106) with opioid use disorder maintained on morphine received 0.4 mg intramuscular naloxone and completed self-report (Subjective Opiate Withdrawal Scale, SOWS), visual analog scale (VAS), Bad Effects and Sick, and observer ratings (Clinical Opiate Withdrawal Scale, COWS). Time to peak severity and minimal clinically important difference (MCID) in withdrawal severity were calculated. Principal component analysis (PCA) during peak severity were conducted and analyzed with repeated measures analyses of variance (ANOVA).
Within 60 min, 89% of people reported peak SOWS ratings and 90% of people had peak COWS scores as made by raters. Self-reported signs of eyes tearing, yawning, nose running, perspiring, hot flashes, and observed changes in pupil diameter and rhinorrhea/lacrimation were uniquely associated with precipitated withdrawal. VAS ratings of Bad Effect and Sick served as statistically significant severity categories (0, 1-40, 41-80, and 81-100) for MCID evaluations and revealed participants' identification with an increase of 10 [SOWS; 15% maximum percent effect (MPE)] and 6 (COWS; 12% MPE) points as meaningful shifts in withdrawal severity indicative of precipitated withdrawal.
Data suggested that a change of 10 (15% MPE) and 6 (12% MPE) points on the SOWS and COWS, respectively, that occurred within 60 min of antagonist administration was identified by participants as a clinically meaningful increase in symptom severity. These data provide a method to begin examining precipitated opioid withdrawal.
阿片类药物戒断可表现为自发和诱发两种综合征。虽然自发戒断的特征已明确，但诱发阿片类药物戒断尚无操作性定义。
维持使用吗啡的阿片类药物使用障碍患者（n = 106）接受0.4mg肌肉注射纳洛酮，并完成自我报告（主观阿片类药物戒断量表，SOWS）、视觉模拟量表（VAS）、不良反应与不适量表，以及观察者评分（临床阿片类药物戒断量表，COWS）。计算戒断严重程度达到峰值的时间以及最小临床重要差异（MCID）。在严重程度峰值时进行主成分分析（PCA），并采用重复测量方差分析（ANOVA）进行分析。
60分钟内，89%的患者报告SOWS评分达到峰值，90%的患者观察者评定的COWS评分达到峰值。自我报告的流泪、打哈欠、流鼻涕、出汗、潮热等体征，以及观察到的瞳孔直径变化和鼻溢/流泪与诱发戒断有独特关联。VAS不良反应与不适评分在MCID评估中作为具有统计学意义的严重程度类别（0、1 - 40、41 - 80和81 - 100），并显示参与者将SOWS增加10分[15%最大效应百分比（MPE）]和COWS增加6分（12% MPE）视为戒断严重程度的有意义变化，表明为诱发戒断。
数据表明，在给予拮抗剂后60分钟内，SOWS和COWS分别出现10分（15% MPE）和6分（12% MPE）的变化，参与者将其视为症状严重程度在临床上有意义的增加。这些数据提供了一种开始研究诱发阿片类药物戒断的方法。
