经皮阿片类药物的口腔和口腔滥用:一种检测不足但可能致命的做法

IF 0.1 Q4 ANESTHESIOLOGY
L. Gistelinck, G. Heylens, S. Schelfout, Glenn Lemmens
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引用次数: 1

摘要

目的:经皮阿片贴片(TOPs)对中重度慢性疼痛综合征患者有效且耐受性良好。然而,它们特殊的药理特性使它们容易被滥用。本文的目的是描述口腔和口腔滥用TOPs的实践,并讨论其临床意义。方法:我们介绍一例患者在口服阿片类透皮贴剂后进入重症监护室。此外,还参考Pubmed和Embase对该主题进行了叙述性文献综述。结果:口腔或口腔滥用TOP是滥用TOP最常见的方法,其次是静脉注射、吸入和应用多种贴片。TOP滥用的主要原因包括吸毒、自杀行为和自我药物治疗。口服可能是致命的,因为在单个贴片中发现了高剂量的芬太尼。口腔滥用导致芬太尼血清浓度快速升高,这是由芬太尼的跨粘膜吸收引起的,从而绕过肝脏代谢。在紧急情况下,考虑到症状复发的高风险,纳洛酮应连续输注。有证据表明,就滥用潜力而言,经皮丁丙诺啡更安全。这可以通过其对呼吸抑制的上限效应和超治疗剂量的低峰值效应来解释。滥用的风险因素包括药物使用障碍史、既往阿片类药物过量和精神疾病。疑似阿片类药物滥用的患者应转诊至疼痛诊所、心理健康专家或戒毒机构。结论:口腔或口腔虐待是最常见的非皮肤形式的TOP虐待。摄入或咀嚼时,TOPs会对健康造成相当大的风险。定期筛查慢性阿片类药物治疗患者的阿片类物质使用障碍至关重要。当遇到有虐待风险的患者时,建议密切监测并转诊至专科护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Oral and buccal abuse of transdermal opioids : an underdetected but potentially lethal practice
Objectives : Transdermal opioid patches (TOPs) are effective and well tolerated in patients with moderate to severe chronic pain syndromes. Their specific pharmacological properties, however, make them prone to abuse. The objective of this article is to describe the practice of oral and buccal abuse of TOPs and to discuss its clinical implications. Methods : We present the case of a patient admitted to the intensive care unit after oral abuse of transdermal opioid patches. Additionally, a narrative literature review on the topic is conducted, referring to Pubmed and Embase. Results : Oral or buccal TOP abuse is the most frequent method of TOP abuse, followed by intravenous injection, inhaling, and applying multiple patches. The main reasons for TOP abuse include drug addiction, suicidal behavior and self-medication. Oral ingestion is potentially lethal because of the high doses of fentanyl that are found in a single patch. Buccal abuse results in fast elevations of fentanyl serum concentrations, caused by transmucosal absorption of fentanyl, thus bypassing hepatic metabolism. During emergency management, naloxone should be administered in a continuous infusion, given the high risk of recurrence of symptoms. Evidence suggests that transdermal buprenorphine is safer in terms of abuse potential. This is explained by its ceiling effect for respiratory depression and its lower peak effects in supratherapeutic doses. Risk factors for abuse include history of substance use disorder, prior opioid overdose and mental illness. Patients with suspected opioid abuse should be referred to pain clinics, mental health specialists or drug addiction facilities. Conclusion : Oral or buccal abuse is the most reported non-dermal form of TOP abuse. When ingested or chewed, TOPs pose considerable health risks. It is critical to screen patients with chronic opioid therapy regularly for opioid use disorder. When confronted with patients at risk of abuse, close monitoring and referral to specialist care is advised.
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来源期刊
CiteScore
0.20
自引率
0.00%
发文量
2
期刊介绍: L’Acta Anaesthesiologica Belgica est le journal de la SBAR, publié 4 fois par an. L’Acta a été publié pour la première fois en 1950. Depuis 1973 l’Acta est publié dans la langue Anglaise, ce qui a été résulté à un rayonnement plus internationaux. Depuis lors l’Acta est devenu un journal à ne pas manquer dans le domaine d’Anesthésie Belge, offrant e.a. les textes du congrès annuel, les Research Meetings, … Vous en trouvez aussi les dates des Research Meetings, du congrès annuel et des autres réunions.
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