Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada.
Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada.
Acad Emerg Med. 2024 May;31(5):504-514. doi: 10.1111/acem.14806. Epub 2023 Oct 19.
Alcohol-related concerns commonly present to the emergency department (ED), with a subset of individuals experiencing the symptoms of an alcohol use disorder (AUD). As such, examining the efficacy of pharmacological anti-craving treatment for AUD in the ED is of increasing interest. The objective of this systematic review was to evaluate the direct evidence assessing the efficacy of providing anti-craving medications for AUD treatment in the ED.
A systematic search was conducted according to the patient-intervention-control-outcome question: (P) adults (≥18 years old) presenting to the ED with an AUD (including suspected AUD); (I) anti-craving medications (i.e., naltrexone, acamprosate, gabapentin); (C) no prescription or placebo; (O) reduction of repeat ED visits, engagement in addiction services, reductions in heavy drinking days, reductions in any drinking and amount consumed (or abstinence), and in relapse. Two reviewers independently assessed articles for inclusion and conducted risk of bias assessments for included studies.
From 143 potentially relevant articles, 6 met inclusion criteria: 3 clinical trials, and 3 case studies. The clinical trials identified evaluated oral versus extended-release naltrexone, monthly extended-release naltrexone injections, and disulfiram. Both oral and extended-release naltrexone resulted in decreased alcohol consumption. Monthly extended-release naltrexone injections resulted in significant improvements in drinking and quality of life. Although out of scope, the disulfiram studies identified did not result in an improvement in drinking in comparison to no medication.
Overall, there are few studies directly examining the efficacy of anti-craving medications for AUD in the ED, although the limited evidence that exists is supportive of naltrexone pharmacotherapy, particularly extended-release injection formulation. Additional randomized controlled trials are necessary for substantive direct evidence on anti-craving medication initiation in the ED.
与酒精相关的问题通常会出现在急诊部（ED），其中一部分人会出现酒精使用障碍（AUD）的症状。因此，研究 ED 中使用药理学抗渴求治疗 AUD 的效果越来越受到关注。本系统综述的目的是评估直接评估在 ED 中提供 AUD 抗渴求药物治疗效果的直接证据。
根据患者干预对照结局问题进行系统搜索：（P）年龄在 18 岁及以上，因 AUD（包括疑似 AUD）就诊于 ED 的成年人；（I）抗渴求药物（即纳曲酮、阿坎酸、加巴喷丁）；（C）无处方或安慰剂；（O）减少重复 ED 就诊、接受成瘾服务、减少重度饮酒天数、减少任何饮酒量和饮酒量（或戒酒）以及减少复发。两位评审员独立评估文章的纳入情况，并对纳入研究进行偏倚风险评估。
从 143 篇可能相关的文章中，有 6 篇符合纳入标准：3 项临床试验和 3 项病例研究。临床试验评估了口服与缓释纳曲酮、每月缓释纳曲酮注射和双硫仑。口服和缓释纳曲酮均可减少酒精摄入量。每月缓释纳曲酮注射可显著改善饮酒和生活质量。尽管不在研究范围内，但与无药物治疗相比，双硫仑研究并未导致饮酒改善。
总体而言，直接评估 ED 中抗渴求药物治疗 AUD 效果的研究较少，尽管现有有限的证据支持纳曲酮药物治疗，特别是缓释注射制剂。需要更多的随机对照试验来提供 ED 中抗渴求药物启动的实质性直接证据。
