Sokolski Eleasa, Skogrand Emily, Goff Amelia, Englander Honora
From the Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, OR (E Sokolski, AG, HE); Department of Pharmacy Services, Oregon Health and Science University, Portland, OR (E Skogrand); and Division of Hospital Medicine, Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR (HE).
J Addict Med. 2023;17(4):e278-e280. doi: 10.1097/ADM.0000000000001133. Epub 2023 Jan 17.
Low-dose buprenorphine initiation allows patients to start buprenorphine for treatment of opioid use disorder (OUD) while continuing full-agonist opioids. This strategy is beneficial for hospitalized patients who may have acute pain and are not able to tolerate withdrawal. However, most protocols require 7-10 to complete, which may create barriers in patients with shorter or unpredictable lengths of stay.
This cohort study examined the efficacy and feasibility of a rapid low-dose buprenorphine initiation protocol in the hospital setting.
We performed a retrospective cohort study of hospitalized patients with OUD (diagnosed by DSM-5 criteria) seen by an addiction medicine consult service at a single academic medical center who started buprenorphine via a rapid low-dose initiation between November 2021 and May 2022. Patients were prospectively tracked using an electronic registry, and data were abstracted from the electronic health record.
Twenty-four patients underwent rapid low-dose initiation during the study period. All patients received full-agonist opioids before starting buprenorphine. Thirteen (54%) patients reported using fentanyl, with 5 patients reported endorsing use within 48 hours preceding buprenorphine initiation. Nineteen (79%) patients completed initiation with an average time to completion of 72 hours. Among patients who reported fentanyl use in the 48 hours before starting buprenorphine, 60% completed initiation and 40% elected to transition to methadone. No patients experienced precipitated withdrawal.
Rapid low-dose buprenorphine initiation provides a feasible and well-tolerated alternative to traditional and slower low-dose initiations for hospitalized patients.
低剂量丁丙诺啡起始治疗可使患者在继续使用完全激动剂阿片类药物的同时，开始使用丁丙诺啡治疗阿片类物质使用障碍（OUD）。这种策略对可能患有急性疼痛且无法耐受戒断的住院患者有益。然而，大多数方案需要7至10天才能完成，这可能会给住院时间较短或不可预测的患者带来障碍。
本队列研究探讨了在医院环境中快速低剂量丁丙诺啡起始方案的疗效和可行性。
我们对一家学术医疗中心成瘾医学咨询服务部门诊治的符合DSM-5标准诊断为OUD的住院患者进行了回顾性队列研究，这些患者在2021年11月至2022年5月期间通过快速低剂量起始方案开始使用丁丙诺啡。使用电子登记系统对患者进行前瞻性跟踪，并从电子健康记录中提取数据。
在研究期间，24名患者接受了快速低剂量起始治疗。所有患者在开始使用丁丙诺啡之前都使用了完全激动剂阿片类药物。13名（54%）患者报告使用过芬太尼，其中5名患者报告在开始使用丁丙诺啡前48小时内使用过。19名（79%）患者完成了起始治疗，平均完成时间为72小时。在开始使用丁丙诺啡前48小时内报告使用过芬太尼的患者中，60%完成了起始治疗，40%选择转用美沙酮。没有患者出现戒断反应。
对于住院患者，快速低剂量丁丙诺啡起始治疗是传统较慢的低剂量起始治疗的一种可行且耐受性良好的替代方案。
