From the Yale AIDS Program, Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (CAF, SAS); Drexel University College of Medicine, Department of Medicine, Division of Infectious Diseases and HIV Medicine, Philadelphia, PA (NS); Division of Infectious Diseases and Epidemiology, Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Hershey, PA (JN, M Schade); Department of Internal Medicine, Addiction Medicine Center, Prisma Health, Greenville, SC (PR, M Strong, AHL); Department of Medicine, University of South Carolina School of Medicine-Greenville, Greenville, SC (AHL); Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY (EVN, FRL); and Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (KTB).
J Addict Med. 2023;17(4):e232-e239. doi: 10.1097/ADM.0000000000001136. Epub 2023 Jan 26.
Persons with opioid use disorder (OUD) suffer disproportionately from morbidity and mortality related to serious addiction-related infections requiring hospitalization. Long-acting buprenorphine (LAB) is an underused medication for OUD that may facilitate linkage to care and treatment retention when administered before hospital discharge. Transition onto buprenorphine in the inpatient setting is often complicated by pain, active infection management, potential surgical interventions, and risk of opioid withdrawal in transition from full agonists to a partial agonist.
The COMMIT Trial is a randomized controlled trial evaluating LAB administered by infectious disease physicians and hospitalists compared with treatment as usual for persons with OUD hospitalized with infections. We report a case series of participants on full agonist opioids including methadone who were transitioned to sublingual buprenorphine using low-dose ( microdosing ) strategies followed by LAB injection.
Seven participants with current opioid use disorder and life-threatening infections, all with significant concurrent pain and many requiring surgical intervention, underwent low-dose transitions starting at buccal buprenorphine doses ranging from 225 μg to 300 μg 3 times a day on the first day. All were well tolerated with average time to LAB injection of 7.5 days (range, 5-10 days).
Inpatient low-dose buprenorphine transition from full agonist opioids including methadone onto LAB is feasible even in those with complex hospitalizations for concurrent infections and/or surgery. This strategy facilitates dosing of LAB before hospital discharge when risk of opioid relapse and overdose are significant.
阿片类药物使用障碍（OUD）患者与严重成瘾相关感染相关的发病率和死亡率不成比例，这些感染需要住院治疗。长效丁丙诺啡（LAB）是一种未充分利用的 OUD 药物，在出院前给药时，可以促进与护理的联系和治疗保留。在住院环境中过渡到丁丙诺啡通常很复杂，因为有疼痛、积极的感染管理、潜在的手术干预以及从完全激动剂过渡到部分激动剂时戒断阿片类药物的风险。
COMMIT 试验是一项随机对照试验，评估传染病医生和医院医生管理的 LAB 与 OUD 感染者的常规治疗相比。我们报告了一系列使用低剂量（微量剂量）策略从全激动剂阿片类药物（包括美沙酮）过渡到舌下丁丙诺啡，然后再过渡到 LAB 注射的参与者的病例系列。
7 名患有当前 OUD 和危及生命的感染的参与者，所有参与者都有明显的并存疼痛，许多人需要手术干预，在第一天开始时接受了从颊部丁丙诺啡剂量为 225 μg 至 300 μg，每天 3 次的低剂量过渡。所有参与者均耐受良好，LAB 注射的平均时间为 7.5 天（范围为 5-10 天）。
即使在因并发感染和/或手术而复杂住院的情况下，从全激动剂阿片类药物（包括美沙酮）过渡到 LAB 的住院低剂量丁丙诺啡也是可行的。这种策略有助于在出院前调整 LAB 的剂量，因为此时阿片类药物复发和过量的风险很高。
