Adams Kathleen K, Cohen Shawn M, Guerra Michael E, Weimer Melissa B
From the Department of Pharmacy Practice, University of Connecticut School of Pharmacy (KKA); Program in Addiction Medicine, Section of General Internal Medicine, Yale School of Medicine (SMC, MBW); and Department of Pharmacy Services, Yale New Haven Hospital Pharmacy Services (MEG).
J Addict Med. 2023;17(4):474-476. doi: 10.1097/ADM.0000000000001146. Epub 2023 Mar 2.
To describe a low-dose buprenorphine initiation strategy with buccal buprenorphine.
This is a case series of hospitalized patients with opioid use disorder (OUD) and/or chronic pain who underwent low-dose buprenorphine initiation with buccal buprenorphine to sublingual buprenorphine. Results are descriptively reported.
Forty-five patients underwent low-dose buprenorphine initiation from January 2020 to July 2021. Twenty-two (49%) patients had OUD only, 5 (11%) patients had chronic pain only, and 18 (40%) patients had both OUD and chronic pain. Thirty-six (80%) patients had documented history of heroin or non-prescribed fentanyl use before admission. Acute pain in 34 (76%) patients was the most commonly documented rationale for low-dose buprenorphine initiation. Methadone was the most common outpatient opioid utilized before admission (53%). The addiction medicine service consulted on 44 (98%) cases and median length of stay was approximately 2 weeks. Thirty-six (80%) patients completed the transition to sublingual buprenorphine with a median completion dose of 16 mg daily. Of the 24 patients (53%) with consistently documented Clinical Opiate Withdrawal Scale scores, no patients experienced severe opioid withdrawal. Fifteen (62.5%) experienced mild or moderate withdrawal and 9 (37.5%) experienced no withdrawal (Clinical Opiate Withdrawal Scale score <5) during the entire process. Continuity of postdischarge prescription refills ranged from 0 to 37 weeks and the median number of buprenorphine refills was 7 weeks.
Low-dose buprenorphine initiation with buccal buprenorphine to sublingual buprenorphine was well tolerated and can be safely and effectively utilized for patients whose clinical scenario precludes traditional buprenorphine initiation strategies.
描述一种使用颊含丁丙诺啡起始低剂量丁丙诺啡的策略。
这是一个病例系列，纳入了患有阿片类物质使用障碍（OUD）和/或慢性疼痛的住院患者，他们接受了从颊含丁丙诺啡起始低剂量丁丙诺啡到舌下含服丁丙诺啡的治疗。结果进行描述性报告。
2020年1月至2021年7月期间，45例患者接受了低剂量丁丙诺啡起始治疗。22例（49%）患者仅患有OUD，5例（11%）患者仅患有慢性疼痛，18例（40%）患者同时患有OUD和慢性疼痛。36例（80%）患者在入院前有海洛因或非处方芬太尼使用记录。34例（76%）患者的急性疼痛是起始低剂量丁丙诺啡最常见的记录理由。美沙酮是入院前最常用的门诊阿片类药物（53%）。成瘾医学服务团队对44例（98%）病例进行了会诊，中位住院时间约为2周。36例（80%）患者完成了向舌下含服丁丙诺啡的转换，中位完成剂量为每日16毫克。在24例（53%）持续记录临床阿片戒断量表评分的患者中，没有患者经历严重的阿片戒断。15例（62.5%）患者经历了轻度或中度戒断，9例（37.5%）患者在整个过程中未经历戒断（临床阿片戒断量表评分<5）。出院后处方续期的连续性为0至37周，丁丙诺啡续期的中位数为7周。
从颊含丁丙诺啡起始低剂量丁丙诺啡到舌下含服丁丙诺啡耐受性良好，对于临床情况不适合传统丁丙诺啡起始策略的患者，可以安全有效地使用。
