Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
Department of Pharmacology, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
Addict Sci Clin Pract. 2023 Jun 1;18(1):38. doi: 10.1186/s13722-023-00392-z.
Hospitalizations are a vital opportunity for the initiation of life-saving opioid agonist therapy (OAT) for patients with opioid use disorder. A novel approach to OAT initiation is the use of IV buprenorphine for low dose induction, which allows patients to immediately start buprenorphine at any point in a hospitalization without stopping full agonist opioids or experiencing significant withdrawal.
This is a retrospective case series of 33 patients with opioid use disorder concurrently treated with full agonist opioids for pain who voluntarily underwent low dose induction at a tertiary academic medical center. Low dose induction is the process of initiating very low doses of buprenorphine at fixed intervals with gradual dose increases in patients who recently received or are simultaneously treated with full opioid agonists. Our study reports one primary outcome: successful completion of the low dose induction (i.e. transitioned from low dose IV buprenorphine to sublingual buprenorphine-naloxone) and three secondary outcomes: discharge from the hospital with buprenorphine-naloxone prescription, self-reported pain scores, and nursing-assessed clinical opiate withdrawal scale (COWS) scores over a 6-day period, using descriptive statistics. COWS and pain scores were obtained from day 0 (prior to starting the low dose induction) to day 5 to assess the effect on withdrawal symptoms and pain control.
Thirty patients completed the low dose induction (30/33, 90.9%). Thirty patients (30/33, 90.9%) were discharged with a buprenorphine prescription. Pain and COWS scores remained stable over the course of the study period. Mean COWS scores for all patients were 2.6 (SD 2.8) on day 0 and 1.6 (SD 2.6) on day 5. Mean pain scores for all patients were 4.4 (SD 2.1) on day 0 and 3.5 on day 5 (SD 2.1).
This study found that an IV buprenorphine low dose induction protocol was well-tolerated by a group of 33 hospitalized patients with opioid use disorder with co-occurring pain requiring full agonist opioid therapy. COWS and pain scores improved for the majority of patients. This is the first case series to report mean daily COWS and pain scores over an extended period throughout a low dose induction process.
住院是为患有阿片类药物使用障碍的患者启动救命性阿片类激动剂治疗 (OAT) 的重要机会。OAT 启动的一种新方法是使用 IV 丁丙诺啡进行低剂量诱导，这允许患者在住院期间的任何时候立即开始丁丙诺啡治疗，而无需停止全激动剂阿片类药物或经历明显的戒断。
这是一项在一家三级学术医疗中心进行的回顾性病例系列研究，涉及 33 名同时接受全激动剂阿片类药物治疗疼痛的阿片类药物使用障碍患者，他们自愿接受低剂量诱导。低剂量诱导是指在最近接受或同时接受全阿片激动剂治疗的患者中，以固定间隔开始非常低剂量丁丙诺啡，并逐渐增加剂量的过程。我们的研究报告了一个主要结果：低剂量诱导成功完成（即从低剂量 IV 丁丙诺啡过渡到舌下丁丙诺啡-纳洛酮）和三个次要结果：在 6 天内出院并开具丁丙诺啡-纳洛酮处方、自我报告的疼痛评分和护理评估的临床阿片类戒断量表 (COWS) 评分，使用描述性统计。COWS 和疼痛评分从第 0 天（开始低剂量诱导之前）到第 5 天获得，以评估对戒断症状和疼痛控制的影响。
30 名患者完成了低剂量诱导（30/33，90.9%）。30 名患者（30/33，90.9%）出院时开具了丁丙诺啡处方。在研究期间，疼痛和 COWS 评分保持稳定。所有患者的平均 COWS 评分在第 0 天为 2.6（SD 2.8），第 5 天为 1.6（SD 2.6）。所有患者的平均疼痛评分在第 0 天为 4.4（SD 2.1），第 5 天为 3.5（SD 2.1）。
本研究发现，一组 33 名患有阿片类药物使用障碍且伴有疼痛的住院患者对 IV 丁丙诺啡低剂量诱导方案耐受良好，这些患者需要全激动剂阿片类药物治疗。大多数患者的 COWS 和疼痛评分都有所改善。这是第一项报告在低剂量诱导过程中延长时间内每日平均 COWS 和疼痛评分的病例系列研究。
