title: Chronic Opioid Users Are More Difficult to Sedate than Alcoholics and Controls.
abstract: OBJECTIVE
  Diagnostic and therapeutic colonoscopy is performed using conscious sedation. Excessive alcohol users, chronic benzodiazepine and opioid users, and polysubstance users are commonly cited as difficult to sedate. Few studies have compared and analyzed medication dosages to achieve sedation in these groups.
  
  
  METHODS
  The endoscopic database was searched for patients who underwent colonoscopy. A retrospective chart review was performed to determine whether each patient was an abuser/chronic user of opioids, benzodiazepines, marijuana, alcohol, or a combination of the above. The mean dose of fentanyl and versed administered in each group was compared.
  
  
  RESULTS
  A total of 239 patients were enrolled. Compared with the alcohol and control groups, the opioid group used a statistically higher mean medication dosage to achieve sedation. The mean dose of fentanyl in the opioid group was 124 μg, the mean dose in the alcohol group was 101 μg, and the mean dose in the control group was 101 μg. The mean dose of midazolam in the opioid group was 4.1 mg, the mean dose in the alcohol group was 3.3 mg, and the mean dose in the control group was 3.3 mg.
  
  
  CONCLUSIONS
  Identifying patients who are difficult to sedate before colonoscopy is important because adequate sedation is associated with better adenoma detection, a better procedural completion rate, and patient satisfaction. In patients using daily opioids, it is important to anticipate the need for higher doses of medication to achieve adequate sedation.
authors.affiliation: From the Departments of Internal Medicine and Gastroenterology, University of South Florida, Tampa, and the Department of Gastroenterology, University of South Carolina, Greenville.
authors.forename: Rupal
authors.initials: R
authors.lastname: Patel
authors.affiliation: From the Departments of Internal Medicine and Gastroenterology, University of South Florida, Tampa, and the Department of Gastroenterology, University of South Carolina, Greenville.
authors.forename: Steven
authors.initials: S
authors.lastname: Clayton
authors.affiliation: From the Departments of Internal Medicine and Gastroenterology, University of South Florida, Tampa, and the Department of Gastroenterology, University of South Carolina, Greenville.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Quintero
authors.affiliation: From the Departments of Internal Medicine and Gastroenterology, University of South Florida, Tampa, and the Department of Gastroenterology, University of South Carolina, Greenville.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gill
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003113:Colonoscopy; D016292:Procedural Sedation; D004305:Dose-Response Relationship, Drug; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000150:complications*
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl