使用芬太尼的患者在治疗第一周开始使用美沙酮 80 毫克:一个阿片类药物门诊治疗项目的病例系列。

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-15 DOI:10.1097/ADM.0000000000001362
Scott Steiger, Caravella McCuistian, Leslie W Suen, Brad Shapiro, D Andrew Tompkins, Alexander R Bazazi
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引用次数: 0

摘要

目标:目前的美沙酮滴定指南可能会不必要地延迟使用芬太尼的患者达到有效剂量的时间,从而导致持续使用芬太尼、对治疗不满意以及过早退出治疗的风险增加。制定和评估美沙酮快速诱导方案可改善对使用芬太尼患者的治疗:方法: 对 2022 年入住一家获得许可的阿片类药物治疗项目(OTP)的患者进行了回顾性病历审查,该项目采用快速诱导方案,在第 1 天为使用芬太尼的患者提供 40 毫克、第 2 天 60 毫克、第 3 天 80 毫克的美沙酮:93 名患者接受了快速诱导,其中 65 人(70%)完成了快速诱导。完成诱导的患者第 7 天的平均剂量为 89 毫克(标清 9.5 毫克),而未完成诱导的患者为 49 毫克(标清 14.0 毫克)。没有观察到过度镇静、非致命性用药过量或死亡事件。30 天后,85% 的患者(79/93)接受了快速方案治疗,其中 88% 的患者(57/65)完成了方案治疗,而 79% 的患者(22/28)未完成方案治疗(OR 1.9,95% CI 0.6-6.2):结论:在这项研究中,对于在单个 OTP 使用芬太尼的门诊患者来说,在第 7 天前快速诱导服用美沙酮 80 毫克是可行的。未发现重大安全事件。
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Induction to Methadone 80 mg in the First Week of Treatment of Patients Who Use Fentanyl: A Case Series From an Outpatient Opioid Treatment Program.

Objectives: Current guidelines for methadone titration may unnecessarily delay reaching effective doses for patients using fentanyl, resulting in an increased risk of ongoing fentanyl use, dissatisfaction with treatment, and early dropout. Development and evaluation of rapid methadone induction protocols may improve treatment for patients using fentanyl.

Methods: Retrospective chart review was conducted for patients admitted in 2022 to a single licensed opioid treatment program (OTP) where a rapid induction protocol provides methadone 40 mg on day 1, 60 mg on day 2, and 80 mg on day 3 to patients using fentanyl <65 years old without significant medical comorbidities. The primary feasibility outcome was completion of the protocol, defined by receipt of methadone dose 80 mg or more on treatment day 7. The primary safety outcomes were oversedation, nonfatal overdose, and death. A secondary outcome was retention in treatment at 30 days.

Results: Rapid induction was ordered for 93 patients and completed by 65 (70%). Average dose on day 7 for patients who completed was 89 mg (SD 9.5 mg) versus 49 mg (SD 14.0 mg) for those who did not. No episodes of oversedation, nonfatal overdose, or death were observed. At 30 days, 85% of the patients who had the rapid protocol ordered (79/93) were retained, with 88% (57/65) who completed the protocol retained versus 79% (22/28) who did not complete (OR 1.9, 95% CI 0.6-6.2).

Conclusions: Rapid induction to methadone 80 mg by day 7 was feasible for outpatients using fentanyl in this study at a single OTP. No significant safety events were identified.

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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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