High-Dose Buprenorphine Initiation: A Scoping Review.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-07-01 Epub Date: 2024-05-16 DOI:10.1097/ADM.0000000000001296
Stanley Wong, Nicholas Fabiano, Declan Webber, Robert A Kleinman
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Abstract

Objective: The aim of the study is to review and synthesize the literature on high-dose buprenorphine initiation (>12-mg total dose on day of initiation).

Methods: A scoping review of literature about high-dose buprenorphine initiation was conducted. MEDLINE, Embase, PsycINFO, and Cochrane Central were searched. Randomized controlled trials, prospective and retrospective cohort studies, and case studies/reports published in English before February 13, 2023, were included.

Results: Fifteen studies reporting outcomes from 580 high-dose buprenorphine initiations were included. Eight studies were in inpatient settings, 3 in emergency departments, 3 in outpatient settings, and 1 in a first-responder setting. Four studies reported high-dose initiations among individuals exposed to fentanyl. There were no reported events of fatal or nonfatal overdose or respiratory depression, although adverse event reporting was inconsistent in published reports. The most reported side effects with high-dose buprenorphine initiation were nausea or vomiting (n = 17) and precipitated withdrawal (n = 7). The most serious reported adverse event was hypotension requiring oral hydration (n = 2). Most studies reported improvements in subjective or objective withdrawal symptoms. The duration of follow-up ranged from none to 8 months.

Conclusions: High-dose buprenorphine initiation has not been associated with reported cases of overdose or respiratory depression. However, the current literature about high-dose buprenorphine is limited by inconsistent side effect reporting, limited power to detect rare safety events such as respiratory depression, limited follow-up data, and few comparison studies between high-dose and regular initiation protocols. Further prospective data are needed to evaluate the safety and effectiveness of this initiation strategy.

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大剂量丁丙诺啡的启动:范围审查。
研究目的本研究旨在回顾和总结有关大剂量丁丙诺啡起始治疗(起始治疗当天总剂量大于 12 毫克)的文献:方法: 对有关大剂量丁丙诺啡起始治疗的文献进行了范围界定审查。检索了 MEDLINE、Embase、PsycINFO 和 Cochrane Central。纳入了 2023 年 2 月 13 日之前用英语发表的随机对照试验、前瞻性和回顾性队列研究以及病例研究/报告:结果:共纳入了 15 项研究,报告了 580 例开始使用大剂量丁丙诺啡的结果。其中 8 项研究在住院环境中进行,3 项在急诊室进行,3 项在门诊环境中进行,1 项在第一反应环境中进行。四项研究报告了暴露于芬太尼的患者开始使用大剂量丁丙诺啡的情况。尽管不良事件报告在已发表的报告中并不一致,但没有关于致命或非致命过量或呼吸抑制事件的报告。报告最多的大剂量丁丙诺啡副作用是恶心或呕吐(17 例)和骤停(7 例)。最严重的不良反应是低血压,需要口服补液(2 例)。大多数研究报告了主观或客观戒断症状的改善情况。随访时间从零到 8 个月不等:结论:开始使用大剂量丁丙诺啡时,并没有出现用药过量或呼吸抑制的报道。然而,目前有关大剂量丁丙诺啡的文献受到以下因素的限制:副作用报告不一致;检测呼吸抑制等罕见安全事件的能力有限;随访数据有限;大剂量和常规启动方案之间的比较研究很少。需要进一步的前瞻性数据来评估这种起始策略的安全性和有效性。
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
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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