Incidence of buprenorphine-precipitated opioid withdrawal in adults with opioid use disorder: A systematic review.

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2024-09-25 DOI:10.1111/add.16646

Caroline Gregory, Krishan Yadav, Jordyn Linders, Lindsey Sikora, Debra Eagles

{"title":"Incidence of buprenorphine-precipitated opioid withdrawal in adults with opioid use disorder: A systematic review.","authors":"Caroline Gregory, Krishan Yadav, Jordyn Linders, Lindsey Sikora, Debra Eagles","doi":"10.1111/add.16646","DOIUrl":null,"url":null,"abstract":"Background and aims: Buprenorphine is an evidence-based treatment for opioid use disorder, and the risk of precipitated withdrawal contributes to its underuse. The goal of this systematic review was to determine the incidence of buprenorphine-precipitated withdrawal in adults with opioid use disorder.Methods: This systematic review was registered on PROSPERO (CRD42023437634). We searched Medline, Embase Classic + Embase, and Cochrane CENTRAL from inception to 10 November 2023, and included original research that reported the incidence of sublingual buprenorphine-precipitated withdrawal in adults with opioid use disorder. Primary screening was completed by four independent reviewers. Full text review, data extraction and risk of bias assessments using the Newcastle Ottawa Scale and the Cochrane Risk of Bias 2 tool were completed by two independent reviewers. The primary outcome was precipitated withdrawal. Secondary outcomes were baseline opioids used, induction dose, initial Clinical Opiate Withdrawal Scale (COWS) score, location of induction, definition and severity of precipitated withdrawal and adverse events. The range of incidence of precipitated withdrawal across studies was described.Results: Our search yielded 10 197 unique citations. Twenty-one cohort and five randomized trials met inclusion criteria (n = 4497, range 20-1293). The overall incidence of precipitated withdrawal ranged from 0 to 13.2%. Nine studies defined precipitated withdrawal; definitions were inconsistent. Most patients used heroin at baseline. The most common initial dose of buprenorphine was between 2 mg and 8 mg (range: 0.075 mg-24 mg). Initial minimum COWS score ranged from 5 to 13. Induction locations included home, inpatient, emergency department, pre-hospital, outpatient and residential units. Of the fifteen studies with cases of precipitated withdrawal, nine studies did not report the severity of withdrawal experienced. Other induction-related adverse events varied. The overall quality of included studies was poor.Conclusions: The best available evidence suggests the incidence of buprenorphine-precipitated withdrawal in adults with opioid use disorder is low and should not be a barrier to use.","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2000,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Addiction","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/add.16646","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and aims: Buprenorphine is an evidence-based treatment for opioid use disorder, and the risk of precipitated withdrawal contributes to its underuse. The goal of this systematic review was to determine the incidence of buprenorphine-precipitated withdrawal in adults with opioid use disorder.

Methods: This systematic review was registered on PROSPERO (CRD42023437634). We searched Medline, Embase Classic + Embase, and Cochrane CENTRAL from inception to 10 November 2023, and included original research that reported the incidence of sublingual buprenorphine-precipitated withdrawal in adults with opioid use disorder. Primary screening was completed by four independent reviewers. Full text review, data extraction and risk of bias assessments using the Newcastle Ottawa Scale and the Cochrane Risk of Bias 2 tool were completed by two independent reviewers. The primary outcome was precipitated withdrawal. Secondary outcomes were baseline opioids used, induction dose, initial Clinical Opiate Withdrawal Scale (COWS) score, location of induction, definition and severity of precipitated withdrawal and adverse events. The range of incidence of precipitated withdrawal across studies was described.

Results: Our search yielded 10 197 unique citations. Twenty-one cohort and five randomized trials met inclusion criteria (n = 4497, range 20-1293). The overall incidence of precipitated withdrawal ranged from 0 to 13.2%. Nine studies defined precipitated withdrawal; definitions were inconsistent. Most patients used heroin at baseline. The most common initial dose of buprenorphine was between 2 mg and 8 mg (range: 0.075 mg-24 mg). Initial minimum COWS score ranged from 5 to 13. Induction locations included home, inpatient, emergency department, pre-hospital, outpatient and residential units. Of the fifteen studies with cases of precipitated withdrawal, nine studies did not report the severity of withdrawal experienced. Other induction-related adverse events varied. The overall quality of included studies was poor.

Conclusions: The best available evidence suggests the incidence of buprenorphine-precipitated withdrawal in adults with opioid use disorder is low and should not be a barrier to use.

查看原文本刊更多论文

阿片类药物使用障碍成人中丁丙诺啡诱发阿片类药物戒断的发生率：系统综述。

背景和目的：丁丙诺啡是一种治疗阿片类药物使用障碍的循证疗法，但其诱发戒断的风险导致其使用不足。本系统性综述旨在确定阿片类药物使用障碍成人中丁丙诺啡诱发戒断的发生率：本系统综述已在 PROSPERO（CRD42023437634）上注册。我们检索了 Medline、Embase Classic + Embase 和 Cochrane CENTRAL，检索时间从开始到 2023 年 11 月 10 日，并纳入了报告阿片类药物使用障碍成人舌下丁丙诺啡诱导戒断发生率的原始研究。初审由四位独立审稿人完成。全文审阅、数据提取以及使用纽卡斯尔渥太华量表和 Cochrane Risk of Bias 2 工具进行的偏倚风险评估由两名独立审稿人完成。主要结果为骤发戒断。次要结果包括阿片类药物的基线使用量、诱导剂量、初始临床阿片类药物戒断量表（COWS）评分、诱导地点、诱发戒断的定义和严重程度以及不良事件。此外，还描述了各研究中预兆性戒断发生率的范围：结果：我们的搜索结果产生了 10 197 条独特的引文。21 项队列试验和 5 项随机试验符合纳入标准（n = 4497，范围 20-1293）。沉淀性戒断的总体发生率从 0% 到 13.2% 不等。九项研究对诱发戒断进行了定义；定义不一致。大多数患者在基线时使用海洛因。最常见的丁丙诺啡初始剂量为 2 毫克至 8 毫克（范围：0.075 毫克至 24 毫克）。初始最低 COWS 得分为 5 到 13 分不等。诱导地点包括家庭、住院病人、急诊科、院前、门诊和住宿单位。在 15 项有诱导戒断病例的研究中，有 9 项研究没有报告戒断的严重程度。其他与诱导相关的不良事件各不相同。纳入研究的总体质量较差：现有的最佳证据表明，成人阿片类药物使用障碍患者中丁丙诺啡诱发戒断的发生率较低，不应成为使用的障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.