Nasal Opioid Agonist Treatment in Patients with Severe Opioid Dependence: A Case Series

被引:5
|
作者
Vogel, Marc [1 ,2 ]
Kock, Patrick [2 ]
Strasser, Johannes [2 ]
Kalbermatten, Christoph [3 ]
Binder, Hannes [4 ]
Dursteler, Kenneth M. [2 ]
Walter, Marc [2 ]
Falcato, Luis [5 ]
Krausz, Michael [6 ]
Kormann, Adrian [3 ]
机构
[1] Psychiat Serv Thurgovia, Div Subst Use Disorders, Psychiat Clin, Munsterlingen, Switzerland
[2] Univ Basel, Psychiat Clin, Basel, Switzerland
[3] ZOPA, Outpatient Addict Treatment, Zug, Switzerland
[4] Psychiat Baselland, Liestal, Switzerland
[5] Arud Ctr Addict Med, Zurich, Switzerland
[6] Univ British Columbia, Inst Mental Hlth, Dept Psychiat, Vancouver, BC, Canada
关键词
Heroin; Diacetylmorphine; Substitution; Route of administration; Harm reduction; INTRANASAL DIAMORPHINE SPRAY; INJECTING-RELATED INJURY; DRUG-USE; HEROIN; PHARMACOKINETICS; PHARMACODYNAMICS; DISEASE; PEOPLE; BURDEN; ROUTE;
D O I
10.1159/000516431
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
Introduction: Opioid agonist treatment (OAT) is the first-line treatment for opioid dependence. Currently available OAT options comprise oral (methadone and morphine) and sublingual (buprenorphine) routes of administration. In Switzerland and some other countries, severely opioid-dependent individuals with insufficient response to oral or sublingual OAT are offered heroin-assisted treatment (HAT), which involves the provision of injected or oral medical heroin (diacetylmorphine [DAM]). However, many patients on treatment with injectable DAM (i-HAT) suffer from injection-related problems such as deteriorated vein status, ulcerations, endocarditis, and abscesses. Other patients who do not respond to oral OAT do not inject but snort opioids, and are not eligible for i-HAT. For this population, there is no other short-acting OAT with rapid onset of action available unless they switch to injecting, which is associated with higher risks. Nasal DAM (n-HAT) could be an alternative treatment option suitable for both populations of patients. Methods: We present a case series of 3 patients on i-HAT who successfully switched to n-HAT. Results/Conclusions: This is the first description of the clinical use of the nasal route of administration for HAT. n-HAT may constitute an important risk-reduced rapid-onset alternative to i-HAT. In particular, it may be suited for patients with injection-related complications, or noninjecting opioid-dependent patients failing to respond to oral OAT.
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页码:80 / 85
页数:6
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