Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Subst Abus. 2023 Jul;44(3):177-183. doi: 10.1177/08897077231185655. Epub 2023 Sep 20.
Outpatient methadone guidelines recommend starting at a low dose and titrating slowly. As fentanyl prevalence and opioid-related mortality increases, there is a need for individuals to rapidly achieve a therapeutic methadone dose. Hospitalization offers a monitored setting for methadone initiation, however dosing practices and safety are not well described.
Retrospective, observational analysis of hospitalized patients with opioid use disorder seen by an inpatient addiction consult team in an academic medical center who were newly initiated on methadone between 2016 and 2022. We calculated initial daily dose, maximum daily dose, timing interval of dose escalation, whether patients were connected to an opioid treatment program (OTP) prior to discharge, whether adverse effects or safety events occurred during the hospitalization, and whether such events were definitely or probably related versus possibly related or unrelated to methadone.
One hundred twelve patients were included. The mean initial daily methadone dose administered was 32 mg (range: 10-90 mg). The mean maximum dose reached was 76.8 mg (range 30-165 mg). The mean number of days from initial to peak dose was 5.6 days (range 1-19 days). Overall, 30% of patients experienced a safety event, most commonly sedation. Only 4 safety events were deemed probably or definitely related to methadone. In regression analyses, there was no significant difference between starting doses among patients with or without sedation but there was a relationship between last dose and the likelihood of any possibly related event, with those ending at a dose of 100 mg or higher having a higher likelihood event, compared to those ending at lower doses (47.8% vs 12.4%, < .001). Seventy-six percent were connected to OTP before discharge.
Among hospitalized patients initiating methadone, rapid dose titration was infrequently associated with related safety events and most were connected to community-based methadone treatment before discharge.
门诊美沙酮指南建议从低剂量开始，并缓慢滴定。随着芬太尼的流行和阿片类相关死亡率的增加，需要迅速达到治疗剂量的美沙酮。住院为美沙酮的起始提供了一个监测环境，但是剂量的使用和安全性并未得到很好的描述。
对 2016 年至 2022 年间在一家学术医疗中心接受住院成瘾咨询团队治疗的新接受美沙酮治疗的阿片类药物使用障碍住院患者进行回顾性、观察性分析。我们计算了初始每日剂量、最大每日剂量、剂量升级的时间间隔、患者在出院前是否已连接到阿片类药物治疗计划（OTP）、住院期间是否发生不良反应或安全事件，以及这些事件是否与美沙酮肯定相关、可能相关还是可能无关或无关。
共纳入 112 例患者。给予的平均初始每日美沙酮剂量为 32mg（范围：10-90mg）。达到的平均最大剂量为 76.8mg（范围 30-165mg）。从初始剂量到峰值剂量的平均天数为 5.6 天（范围 1-19 天）。总体而言，30%的患者发生了安全事件，最常见的是镇静。只有 4 起安全事件被认为与美沙酮肯定或可能相关。在回归分析中，镇静组和非镇静组患者的起始剂量无显著差异，但末次剂量与可能相关事件的发生概率之间存在关系，与结束剂量为 100mg 或更高的患者相比，结束剂量较低的患者发生事件的可能性更高（47.8% vs 12.4%，<0.001）。76%的患者在出院前已连接到 OTP。
在接受美沙酮治疗的住院患者中，快速剂量滴定很少与相关的安全事件相关，并且大多数患者在出院前已连接到社区美沙酮治疗。
