Feasibility and Safety of a Paramedic-Directed Prehospital Buprenorphine Initiation Protocol for Acute Opioid Withdrawal.

IF 2.1 3区 医学 Q2 EMERGENCY MEDICINE
Nicholas S Simpson, Timothy M Kummer, Holly M Drone, Michael C Perlmutter, Alexander M Schin, Jon B Cole, Brian E Driver, Michael A Puskarich, Maureen E Martin, Alec J Bunting, Aaron E Robinson
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引用次数: 0

Abstract

Objectives: The epidemic of opioid use disorder (OUD) remains pervasive in the United States. In an effort to increase the availability and timeliness of medications for opioid use disorder (MOUD), several agencies in the United States (US) offer buprenorphine by prehospital providers to selected patients, though published data remains limited. We describe the preliminary safety and feasibility of training all paramedics within a single agency to administer buprenorphine in the field without online medical control to simultaneously treat opioid withdrawal and initiate MOUD.

Methods: Using data from an ongoing quality assurance (QA) database, cases were retrospectively reviewed. Inclusion criteria included administration of buprenorphine by paramedics; cases were excluded if administered prior to EMS arrival on scene (i.e., the patient was given buprenorphine by a bystander or took their own). Data were entered into a REDCap database as part of the ongoing QA process. The primary reported outcome was administration of buprenorphine without complications. Complications were defined as any adverse effects from the administration of medication, including but not limited to new or worsening opioid withdrawal symptoms.

Results: In total, 121 patients met inclusion criteria, 82 were treated for naloxone-induced withdrawal and 39 for withdrawal due to opioid cessation. There were no cases of precipitated withdrawal or worsening of patient condition observed. Adverse effects were limited to three cases of nausea and vomiting post-administration, all of which were present prior to buprenorphine administration. No patients met the primary outcome of adverse effects from medication administration.

Conclusions: In a single prehospital system, the use of buprenorphine appears to be a feasible and safe strategy for treating patients experiencing acute opioid withdrawal.

辅助医务人员指导的急性阿片类药物戒断院前丁丙诺啡启动方案的可行性和安全性。
目标:阿片类药物使用失调症(OUD)在美国仍然普遍流行。为了提高阿片类药物使用障碍(MOUD)药物的可用性和及时性,美国的一些机构通过院前医疗服务提供者向特定患者提供丁丙诺啡,但公布的数据仍然有限。我们介绍了在一个机构内对所有护理人员进行培训,使其能够在没有在线医疗控制的情况下在现场使用丁丙诺啡,以同时治疗阿片类药物戒断和启动 MOUD 的初步安全性和可行性:方法:利用正在进行的质量保证(QA)数据库中的数据,对病例进行回顾性审查。纳入标准包括由医护人员施用丁丙诺啡;在急救人员到达现场之前施用丁丙诺啡的病例将被排除在外(即患者由旁观者给予丁丙诺啡或自行服用丁丙诺啡)。数据被输入 REDCap 数据库,作为持续质量保证流程的一部分。报告的主要结果是使用丁丙诺啡时未出现并发症。并发症是指用药过程中出现的任何不良反应,包括但不限于新出现或加重的阿片类戒断症状:共有121名患者符合纳入标准,其中82名患者接受了纳洛酮诱导的戒断治疗,39名患者接受了阿片类药物戒断治疗。没有观察到骤然戒断或患者病情恶化的病例。不良反应仅限于用药后出现的三例恶心和呕吐,所有这些症状都是在服用丁丙诺啡之前出现的。没有患者达到用药不良反应的主要结果:在单个院前系统中,使用丁丙诺啡治疗阿片类药物急性戒断患者似乎是一种可行且安全的策略。
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来源期刊
Prehospital Emergency Care
Prehospital Emergency Care 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.30
自引率
12.50%
发文量
137
审稿时长
1 months
期刊介绍: Prehospital Emergency Care publishes peer-reviewed information relevant to the practice, educational advancement, and investigation of prehospital emergency care, including the following types of articles: Special Contributions - Original Articles - Education and Practice - Preliminary Reports - Case Conferences - Position Papers - Collective Reviews - Editorials - Letters to the Editor - Media Reviews.
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