학술논문
Buprenorphine Continuation During Critical Illness Associated With Decreased Inpatient Opioid Use in Individuals Maintained on Buprenorphine for Opioid Use Disorder in a Retrospective Study.
Document Type
Academic Journal
Author
Quaye A; Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, ME, USA.; Spectrum Healthcare Partners, South Portland, ME, USA.; Wampole C; Department of Pharmacy, Maine Medical Center, Portland, ME, USA.; Riker RR; Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.; Tufts University School of Medicine, Boston, MA, USA.; Seder DB; Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.; Tufts University School of Medicine, Boston, MA, USA.; Sauer WJ; Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, ME, USA.; Spectrum Healthcare Partners, South Portland, ME, USA.; Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.; Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.; Richard JM; Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, ME, USA.; Craig WY; MaineHealth Institute for Research, Scarborough, ME, USA.; Gagnon DJ; Department of Pharmacy, Maine Medical Center, Portland, ME, USA.; Tufts University School of Medicine, Boston, MA, USA.; MaineHealth Institute for Research, Scarborough, ME, USA.
Source
Publisher: Wiley Country of Publication: England NLM ID: 0366372 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-4604 (Electronic) Linking ISSN: 00912700 NLM ISO Abbreviation: J Clin Pharmacol Subsets: MEDLINE
Subject
Language
English
Abstract
The number of patients maintained on buprenorphine is steadily increasing. To date, no study has reported buprenorphine management practices for these patients during critical illness, nor its relationship with supplemental full-agonist opioid administration during their hospital stay. In this single-center retrospective study, we have explored the incidence of buprenorphine continuation during critical illness among patients receiving buprenorphine for the treatment of opioid use disorder. Additionally, we investigated the relationship between nonbuprenorphine opioid exposure and buprenorphine administration during the intensive care unit (ICU) and post-ICU phases of care. Our study included adults maintained on buprenorphine for opioid use disorder admitted to the ICU between December 1, 2014, and May 31, 2019. Nonbuprenorphine, full agonist opioid doses were converted to fentanyl equivalents (FEs). Fifty-one (44%) patients received buprenorphine during the ICU phase of care, with an average dose of 8 (8-12) mg/day. During the post-ICU phase of care, 68 (62%) received buprenorphine, with an average dose of 10 (7-14) mg/day. Lack of mechanical ventilation and acetaminophen use were also associated with buprenorphine use. Full agonist opioid use was more frequent on days when buprenorphine was not given (odds ratio [OR], 6.2 [95% CI, 2.3-16.4]; P < .001). Additionally, the average cumulative dose of opioids given on nonbuprenorphine administration days was significantly higher both in the ICU (OR, 1803 [95% CI, 1271-2553] vs OR, 327 [95% CI, 152-708] FEs/day; P < 0.001) and after ICU discharge (OR, 1476 [95% CI, 962-2265] vs OR, 238 [95% CI, 150-377] FEs/day; P < .001). Given these findings, buprenorphine continuation during critical illness should be considered, as it is associated with significantly decreased full agonist opioid use.
(© 2023, The American College of Clinical Pharmacology.)
(© 2023, The American College of Clinical Pharmacology.)