Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America.
Am J Emerg Med. 2024 Nov;85:130-139. doi: 10.1016/j.ajem.2024.08.036. Epub 2024 Sep 4.
Treating opioid use disorder has reached a new level of challenge. Synthetic opioids and xylazine have joined the non-medical opioid supply, multiplying the complexities of caring for individuals in emergency departments (ED). This combination, known as 'tranq dope,' is poorly described in literature. Inadequate withdrawal treatment results in a disproportionately high rate of patient-directed discharges (also known as against medical advice dispositions, or AMA). This study aimed to describe a cohort of individuals who received a novel order set for suspected fentanyl and xylazine withdrawal in the ED.
This is a descriptive study evaluating a cohort of ED patients who received withdrawal medications from a novel protocol and electronic health record order set. Individuals being assessed in the ED while suffering from withdrawal were eligible. Individuals under age 18, on stable outpatient MOUD or who were pregnant were excluded. Treatment strategies included micro-induction buprenorphine, short acting opioids, non-opioid analgesics, and other adjunctive medications. Data collected included: demographics including zip code, urine toxicology screening, order set utilization and disposition data. Clinical Opiate Withdrawal Scale (COWS) scores were recorded, where available, before and following exposure to the medications.
There were 270 patient encounters that occurred between September 14, 2022, and March 9, 2023 included in the total study cohort. Of those, 66 % were male, mean age 37 with 71 % residing within Philadelphia zip codes. 100 % of urine toxicology screenings were positive for fentanyl. Of the 177 patients with both pre- and post-exposure COWS scores documented, constituting the final cohort, patients receiving medications had their COWS score decrease from a median of 12 to a median of 4 (p < 0.001). The AMA rate for this cohort was 3.9 %, whereas the baseline for the population with OUD was 10.7 %. Recorded adverse effects were few and resolved without complication.
Fentanyl and xylazine withdrawal are challenging for patients and providers. A novel tranq dope withdrawal order set may reduce both COWS scores and rate of patient-directed discharge in this cohort of patients, though further investigation is needed to confirm findings.
治疗阿片类药物使用障碍已达到新的挑战水平。合成阿片类药物和二甲苯佐卡因已加入非医疗用阿片类药物供应，使急诊科（ED）中个体的护理变得更加复杂。这种组合被称为“tranq dope”，在文献中描述得很少。戒断治疗不足导致患者定向出院（也称为违反医嘱处置，或 AMA）的比例过高。本研究旨在描述接受 ED 中疑似芬太尼和二甲苯佐卡因戒断新型医嘱集的患者队列。
这是一项描述性研究，评估了接受新型方案和电子健康记录医嘱集戒断药物的 ED 患者队列。在 ED 中接受评估且正在戒断的个体符合条件。年龄在 18 岁以下、稳定的门诊美沙酮或怀孕的个体被排除在外。治疗策略包括微诱导丁丙诺啡、短效阿片类药物、非阿片类镇痛药和其他辅助药物。收集的数据包括：人口统计学数据（包括邮政编码）、尿液毒理学筛查、医嘱集利用情况和处置数据。记录了临床阿片类药物戒断量表（COWS）评分，在有记录的情况下，在接触药物前后进行记录。
共有 270 例患者在 2022 年 9 月 14 日至 2023 年 3 月 9 日期间接受了研究，包括在总研究队列中。其中，66%为男性，平均年龄为 37 岁，71%居住在费城邮政编码内。100%的尿液毒理学筛查均呈芬太尼阳性。在有记录的 177 例患者中，他们的 COWS 评分在接受药物治疗前后都有记录，构成了最终队列，接受药物治疗的患者的 COWS 评分从 12 分中位数下降到 4 分中位数（p<0.001）。该队列的 AMA 率为 3.9%，而患有 OUD 的人群的基线率为 10.7%。记录的不良反应很少，且没有并发症就解决了。
芬太尼和二甲苯佐卡因戒断对患者和提供者来说都是具有挑战性的。新型 tranq dope 戒断医嘱集可能会降低这个患者队列的 COWS 评分和患者定向出院率，但需要进一步调查来确认结果。
