在医院试行快速美沙酮芬太尼启动方案。

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE
Journal of Addiction Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-03 DOI:10.1097/ADM.0000000000001324
Patricia Liu, Brian Chan, Eleasa Sokolski, Alisa Patten, Honora Englander
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引用次数: 0

摘要

目标:治疗阿片类药物急性戒断和提供治疗阿片类药物使用障碍(OUD)的药物至关重要。住院治疗为快速启动美沙酮治疗 OUD 提供了一个独特的机会;然而,目前几乎没有临床指南。本报告介绍了我们在引入基于医院的美沙酮快速启动方案后前 9 个月的经验:我们对 2022 年 12 月至 2023 年 8 月期间在一家城市学术中心接受跨专业成瘾医学咨询服务的 OUD 住院患者进行了回顾性病历审查。我们确定了使用美沙酮快速起始方案开始使用美沙酮的患者,该方案包括剂量建议(第 1 天最多 60 毫克,第 2 天 70 毫克,第 3 天 80 毫克,第 4-7 天 100 毫克)和严格的纳入和排除标准(终末器官衰竭、心律失常、同时使用苯二氮卓类药物或饮酒、年龄大于 65 岁):在研究期间,共有 171 名患者接受了美沙酮治疗 OUD。其中,25 名患者(15%)接受了美沙酮快速起始治疗。第 1-7 天的美沙酮日平均总剂量分别为 53.0 毫克、69.2 毫克、75.4 毫克、79.5 毫克、87.1 毫克、92.2 毫克和 96.6 毫克。没有发生需要暂停美沙酮计划剂量、使用纳洛酮或转到更高级护理的不良事件:结论:针对 OUD 的美沙酮快速启动方案可以在住院环境中实施。与传统的诱导方法相比,患者能更快地增加美沙酮剂量,而且没有出现严重的不良反应。适当选择患者对于避免伤害可能很重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Piloting a Hospital-Based Rapid Methadone Initiation Protocol for Fentanyl.

Objectives: Treating acute opioid withdrawal and offering medications for opioid use disorder (OUD) is critical. Hospitalization offers a unique opportunity to rapidly initiate methadone for OUD; however, little clinical guidance exists. This report describes our experience during the first 9 months following introduction of a hospital-based rapid methadone initiation protocol.

Methods: We conducted a retrospective chart review of hospitalized patients with OUD seen by our interprofessional addiction medicine consult service at an urban academic center between December 2022 and August 2023. We identified patients who initiated methadone using the rapid methadone initiation protocol, which includes dose recommendations (maximum 60 mg day 1, 70 mg day 2, 80 mg day 3, 100 mg days 4-7) and strict inclusion and exclusion criteria (end organ failure, arrhythmia, concurrent benzodiazepine or alcohol use, age >65).

Results: There were 171 patients that received methadone for OUD during the study period. Of those, 25 patients (15%) received rapid methadone initiation. The average total daily dose of methadone on days 1-7 was 53.0 mg, 69.2 mg, 75.4 mg, 79.5 mg, 87.1 mg, 92.2 mg, and 96.6 mg, respectively. There were no adverse events requiring holding a dose of scheduled methadone, naloxone administration, or transfer to higher level of care.

Conclusions: A rapid methadone initiation protocol for OUD can be implemented in the inpatient setting. Patients up-titrated their methadone doses quicker than with traditional induction methods, and there were no serious adverse events. Appropriate patient selection may be important to avoid harms.

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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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