Rapid Low-dose Buprenorphine Initiation for Hospitalized Patients With Opioid Use Disorder

被引:5
作者
Sokolski, Eleasa [1 ,4 ]
Skogrand, Emily [2 ]
Goff, Amelia [1 ]
Englander, Honora [1 ,3 ]
机构
[1] Oregon Hlth & Sci Univ, Dept Med, Div Gen Internal Med & Geriatr, Sect Addict Med, Portland, OR USA
[2] Oregon Hlth & Sci Univ, Dept Pharm Serv, Portland, OR USA
[3] Oregon Hlth & Sci Univ, Div Hosp Med, Dept Med, Sect Addict Med, Portland, OR USA
[4] Oregon Hlth & Sci Univ, Dept Med, Div Gen Internal Med & Geriatr, Sect Addict Med, Mail Code UHN30,3181SW Sam Jackson Pk Rd, Portland, OR 97239 USA
关键词
opioid use disorder; buprenorphine; low-dose initiation; microinduction;
D O I
10.1097/ADM.0000000000001133
中图分类号
R194 [卫生标准、卫生检查、医药管理];
学科分类号
摘要
IntroductionLow-dose buprenorphine initiation allows patients to start buprenorphine for treatment of opioid use disorder (OUD) while continuing full-agonist opioids. This strategy is beneficial for hospitalized patients who may have acute pain and are not able to tolerate withdrawal. However, most protocols require 7-10 to complete, which may create barriers in patients with shorter or unpredictable lengths of stay.ObjectiveThis cohort study examined the efficacy and feasibility of a rapid low-dose buprenorphine initiation protocol in the hospital setting.MethodsWe performed a retrospective cohort study of hospitalized patients with OUD (diagnosed by DSM-5 criteria) seen by an addiction medicine consult service at a single academic medical center who started buprenorphine via a rapid low-dose initiation between November 2021 and May 2022. Patients were prospectively tracked using an electronic registry, and data were abstracted from the electronic health record.ResultsTwenty-four patients underwent rapid low-dose initiation during the study period. All patients received full-agonist opioids before starting buprenorphine. Thirteen (54%) patients reported using fentanyl, with 5 patients reported endorsing use within 48 hours preceding buprenorphine initiation. Nineteen (79%) patients completed initiation with an average time to completion of 72 hours. Among patients who reported fentanyl use in the 48 hours before starting buprenorphine, 60% completed initiation and 40% elected to transition to methadone. No patients experienced precipitated withdrawal.ConclusionsRapid low-dose buprenorphine initiation provides a feasible and well-tolerated alternative to traditional and slower low-dose initiations for hospitalized patients.
引用
收藏
页码:E278 / E280
页数:3
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