Addiction, Год журнала: 2024, Номер unknown
Опубликована: Ноя. 4, 2024
Provision of buprenorphine treatment for opioid use disorder is often stymied by clinicians' concerns precipitated withdrawal. Gregory et al.'s [1] systematic review identified a low level withdrawal with induction even among persons who reported fentanyl use. Evidence, not fear should guide treatment. and colleagues conducted published original research between 2002 2023 that on the incidence buprenorphine-precipitated in adults (OUD). Secondary outcomes explored were baseline type opioids used, dose, initial Clinical Opiate Withdrawal Scale (COWS) score, location (e.g. home, healthcare setting), definition severity adverse events. A total 26 studies included where majority within United States (US) (84.6%, n = 22) (80.7%, 21) cohort only 19.2% (n 5) being RCTs. The participants heroin at four having variety types protocols used from standard, high to micro strategies there various doses ranging 0.75 24 mg, reporting 2 8 far lower than recommended target 16 mg [2] or more recent dose higher [3, 4]. bottom line this was hardly any (range 0%–13.2%) out an overall sample size 4497 individuals. In fact, 11 representing 2117 persons, no all. Further, 87 cases outpatient settings one person received via home protocol requiring inpatient hospitalization. This information important many other showing prevalence relatively when initiating buprenorphine, clinicians be guided they will cause deciding about initiation life-saving If wants needs their OUD denied treatment, then are risk overdose death. significance these findings cannot overstated. Although has been good news 10% reduction deaths 2024 [5], over million Americans have died drug overdoses [6]. all involve largely driven presence illicitly manufactured synthetic fentanyl, which contributes almost 90% fatal States. All three forms US Food Drug Administration approved medications opioid-use (MOUD): methadone extended-release naltrexone, reduce craving, use, Additionally, also treat because agonist properties. Buprenorphine found most effective form MOUD [7] through reducing death 50% [8] can provided care primary specialty substance programs. Unfortunately, however, 22% 2.5 American receive [9]. There numerous reasons why so few people could benefit receiving it; main issues reluctance initiate precipitating as discussed al. [1]. reason concerned if given too soon patients report full agonists after cessation like [10-12]. up 2023, continue show either during traditional sublingual well long-acting injectable emergency room [13, 14] in-patient [15, 16]. Careful ensure likelihood while treating lead successful [17, 18]. It our job access life saving ask it opposed providing eliciting is, course, consideration, patient shared decision making education successfully start safely. Withholding someone puts Let us let us, rather evidence get need it. Sandra Springer paid scientific consultation Alkermes, in-kind study donations Alkermes Indivior Pharmaceutical Company National Institutes Health funded research. Data sharing applicable article new data created analyzed study.
Язык: Английский
