Sharma Anjalee, Dunn Kelly E, Schmid-Doyle Katja, Dowell Sarah, Kim Narie, Strain Eric C, Bergeria Cecilia
From the Johns Hopkins School of Medicine, Behavioral Pharmacology Research Unit, Baltimore, MD (AS, KED, KS-D, SD, NK, ECS, CB); and Friends Research Institute Baltimore, MD, (AS).
J Addict Med. 2025;19(2):172-178. doi: 10.1097/ADM.0000000000001395. Epub 2024 Nov 26.
Illicitly manufactured fentanyl has largely replaced heroin throughout the United States. Characteristics of fentanyl-specific withdrawal are not well understood compared to traditional opioid withdrawal. This study examines opioid withdrawal severity among 2 cohorts of study participants who underwent identical morphine stabilization procedures before and after fentanyl was introduced to the local drug market.
The Non-Fentanyl study (n = 103) included participants testing positive for non-fentanyl opioids, and the Fentanyl study (n = 30) included participants testing positive for fentanyl. Both studies completed a 7-day morphine stabilization protocol (30 mg subcutaneous, 4 times daily) and multiple daily self-report and observer-rated assessments of opioid withdrawal and vital signs. Two-way repeated-measures analyses of variance (ANOVAs) examined the effects of study, time, and study × time on daily peak ratings for each outcome.
There were significant elevations in self-report and observer-rated withdrawal scores among the Fentanyl versus Non-Fentanyl study (study × time, P < 0.05) during stabilization days 2-5 and days 2-6, respectively. There was a higher rate of tachycardia among the Fentanyl group compared to the Non-Fentanyl study, and peak diastolic blood pressure was greater among the Fentanyl study compared to the Non-Fentanyl study.
Individuals with fentanyl exposure were less stabilized by morphine and experienced more severe opioid withdrawal via several metrics compared to persons with non-fentanyl opioid exposure. Withdrawal also remained elevated for several days despite morphine initiation. Adjustments to existing treatment induction protocols may be needed given the permeation of fentanyl into the heroin supply.
在美国，非法制造的芬太尼已在很大程度上取代了海洛因。与传统阿片类药物戒断相比，芬太尼特异性戒断的特征尚未得到充分了解。本研究调查了两组研究参与者的阿片类药物戒断严重程度，这两组参与者在芬太尼进入当地毒品市场之前和之后都接受了相同的吗啡稳定程序。
非芬太尼研究（n = 103）包括非芬太尼类阿片药物检测呈阳性的参与者，芬太尼研究（n = 30）包括芬太尼检测呈阳性的参与者。两项研究均完成了为期7天的吗啡稳定方案（皮下注射30毫克，每日4次），并对阿片类药物戒断和生命体征进行了多次每日自我报告和观察者评分评估。双向重复测量方差分析（ANOVA）检验了研究、时间以及研究×时间对每个结局每日峰值评分的影响。
在稳定期的第2 - 5天和第2 - 6天，芬太尼研究组与非芬太尼研究组相比，自我报告和观察者评分的戒断分数分别有显著升高（研究×时间，P < 0.05）。与非芬太尼研究组相比，芬太尼组的心动过速发生率更高，芬太尼研究组的舒张压峰值也更高。
与非芬太尼类阿片药物接触者相比，接触芬太尼的个体使用吗啡后稳定性较差，并且通过多种指标经历了更严重的阿片类药物戒断。尽管开始使用吗啡，但戒断症状在数天内仍居高不下。鉴于芬太尼已渗透到海洛因供应中，可能需要对现有的治疗诱导方案进行调整。
