Standard Versus Rapid Inpatient Methadone Titration for Pregnant Patients With Opioid Use Disorder: A Retrospective Cohort Study.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE
Journal of Addiction Medicine Pub Date : 2024-11-01 Epub Date: 2024-06-24 DOI:10.1097/ADM.0000000000001339
Neel S Iyer, Emily B Ferguson, Vivian Z Yan, Dennis J Hand, Diane J Abatemarco, Rupsa C Boelig
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引用次数: 0

Abstract

Objectives: Our study evaluated if rapid inpatient titration of methadone for pregnant patients with opioid use disorder (OUD) improved outcomes without increasing the risk for overdose.

Methods: This is a retrospective cohort study of pregnant patients admitted for inpatient methadone titration from January 2020 to June 2022. Outcomes were compared between standard versus rapid titration protocols. Standard titration involved an initial methadone dose with additional doses every 6 hours if clinical opiate withdrawal score (COWS) is >9. Rapid titration involved an initial methadone dose with additional doses every 4 hours if COWS is >9. The primary outcome was time required to achieve stable dose. Secondary outcomes included elopement prior to achieving stable dose, methadone-related readmission, opioid overdose, and final dose.

Results: There were 97 patients in the standard titration (STP) and 97 patients in the rapid titration (RTP) groups. Demographic characteristics and substance use history did not differ between the 2 groups. Time to stable dose did not differ between the 2 groups (RTP, 5.0 days ±4.0; STP, 4.0 days ±3.0; P = 0.08). Patients in the rapid titration group were less likely to elope from the hospital prior to stabilization (RTP 23.0% vs STP 37.9%, P = 0.03) and had fewer methadone-related readmissions ( P < 0.001). One patient (1.0%) in the RTP group required naloxone treatment while inpatient for concern for overdose, while none did in the STP group ( P = 0.32). There was no difference in median final stable dose between the 2 groups ( P = 0.07).

Conclusions: Rapid titration of methadone for pregnant patients with OUD was associated with decreased medical elopement and methadone-related readmission, without increasing the risk for overdose.

阿片类药物使用失调妊娠患者的标准美沙酮与快速住院美沙酮滴定:一项回顾性队列研究。
摘要:目的:我们的研究评估了对妊娠期阿片类药物使用障碍(OUD)患者进行美沙酮快速住院滴定是否能在不增加用药过量风险的情况下改善治疗效果:我们的研究评估了妊娠期阿片类药物使用障碍(OUD)患者在住院期间快速滴定美沙酮是否能在不增加用药过量风险的情况下改善治疗效果:这是一项回顾性队列研究,研究对象是 2020 年 1 月至 2022 年 6 月期间住院接受美沙酮滴定治疗的妊娠患者。比较了标准滴定方案和快速滴定方案的结果。标准滴注包括初始美沙酮剂量,如果临床鸦片制剂戒断评分(COWS)大于 9 分,则每 6 小时追加一次剂量。快速滴注包括初始美沙酮剂量,如果 COWS >9 则每 4 小时追加一次剂量。主要结果是达到稳定剂量所需的时间。次要结果包括达到稳定剂量前的脱逃、美沙酮相关再入院、阿片类药物过量和最终剂量:标准滴定(STP)组和快速滴定(RTP)组各有 97 名患者。两组患者的人口统计学特征和药物使用史无差异。两组患者达到稳定剂量的时间没有差异(RTP,5.0 天 ±4.0;STP,4.0 天 ±3.0;P = 0.08)。快速滴定组患者在剂量稳定前私自出院的可能性较小(RTP 23.0% vs STP 37.9%,P = 0.03),与美沙酮相关的再住院率较低(P < 0.001)。RTP 组中有一名患者(1.0%)在住院期间因担心用药过量而需要纳洛酮治疗,而 STP 组中则没有(P = 0.32)。两组的最终稳定剂量中位数没有差异(P = 0.07):结论:对妊娠合并 OUD 患者快速滴定美沙酮与减少逃医和美沙酮相关再入院有关,但不会增加用药过量的风险。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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