Intravenous Fentanyl for Symptom Management in Hospitalized Patients With Refractory Opioid Withdrawal: A Retrospective Cohort Study.

IF 3.2 3区医学 Q1 SUBSTANCE ABUSE

Journal of Addiction Medicine Pub Date : 2025-07-01 Epub Date: 2025-05-01 DOI:10.1097/ADM.0000000000001498

Julia Zazoulina, Seonaid Nolan, Nadia Fairbairn, Andrea Ryan, Brittany B Dennis, Paxton Bach

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引用次数: 0

Abstract

Objectives: Potent synthetic opioids in the drug supply have resulted in patients with increasingly refractory opioid withdrawal syndromes. This study describes patient characteristics and short-term treatment outcomes for a cohort of hospitalized individuals with opioid use disorder (OUD) treated with intravenous fentanyl for opioid withdrawal.

Methods: A retrospective cohort study of inpatients with fentanyl use disorder and refractory opioid withdrawal, treated with intravenous fentanyl at St. Paul's Hospital (Vancouver, Canada) between November 2019 and December 2021. Descriptive variables included sociodemographic factors, substance use history, and fentanyl dosing. Treatment outcomes included retention in the hospital and initiation of medication for opioid use disorder (MOUD). Safety outcomes included opioid toxicity (excessive drowsiness, myoclonus, administration of naloxone, etc) and transfer to a higher level of care.

Results: Fifty-nine encounters were identified, consisting of 43 individuals (56% men), with 56% (n = 24) hospitalized with infection. Intravenous fentanyl bolus doses ranged from 250-5000 mcg. In 71% of encounters (n = 42), patients were prescribed 1000 mcg intravenously every 1-2 hours as needed. The average maximum dose received within 24 hours was a median of 6000 mcg (IQR: 3500-10150 mcg). Patients received a median of 9 days of treatment (IQR: 5-16 d). At discharge, 80% of encounters (n = 47) received an MOUD prescription. Opioid toxicity occurred in 19% of encounters (n = 11), including 8% (n = 5) overdoses. All overdose events involved the use of unregulated fentanyl.

Conclusions: Prescribed intravenous fentanyl may support the management of refractory opioid withdrawal for hospitalized patients with severe OUD. Further evaluation of approaches to manage patients with tolerance to fentanyl and other high-potency opioids is a research priority.

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静脉注射芬太尼治疗难治性阿片类戒断住院患者的症状管理：一项回顾性队列研究。

目的：药物供应中的强效合成阿片类药物导致患者出现越来越难治的阿片类戒断综合征。本研究描述了一组接受静脉芬太尼治疗阿片类药物戒断的阿片类药物使用障碍（OUD）住院患者的患者特征和短期治疗结果。方法：对2019年11月至2021年12月在加拿大温哥华圣保罗医院静脉注射芬太尼治疗的芬太尼使用障碍和难治性阿片类药物戒断的住院患者进行回顾性队列研究。描述性变量包括社会人口因素、药物使用史和芬太尼剂量。治疗结果包括住院和阿片类药物使用障碍（mod）的开始用药。安全性结果包括阿片类药物毒性（过度嗜睡、肌颤、服用纳洛酮等）和转移到更高级别的护理。结果：确定了59次接触，包括43人（56%男性），其中56% （n = 24）因感染住院。静脉注射芬太尼丸的剂量范围为250-5000微克。在71%的病例中（n = 42），患者根据需要每1-2小时静脉注射1000微克。24小时内接受的平均最大剂量中位数为6000微克（IQR: 3500-10150微克）。患者接受中位9天治疗（IQR: 5-16 d）。出院时，80%的患者（n = 47）接受了mod处方。19% （n = 11）发生阿片类药物毒性，其中8% （n = 5）过量服用。所有过量事件都涉及使用未受管制的芬太尼。结论：处方静脉注射芬太尼可能支持重症OUD住院患者难治性阿片类药物戒断的管理。进一步评估对芬太尼和其他高效阿片类药物耐受患者的管理方法是一项研究重点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

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.