A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world.
A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world.
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DOI：
10.1097/adm.0000000000000045
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发表时间：
2014-09
影响因子：
5.5
通讯作者：
Walsh SL
中科院分区：
文献类型：
--
作者：
Lofwall MR;Walsh SL
丁丙诺啡舌下含药疗法(OBOT)在美国和国外的门诊阿片成瘾治疗已迅速推广，随着药物供应的增加，人们对其转移、滥用和相关危害的担忧也越来越多。这篇叙述性综述定义了转移和误用的行为，考察了丁丙诺啡单独和与纳洛酮联合使用对其滥用易感性的影响，描述了丁丙诺啡转移和静脉误用的流行病学数据，静脉误用的危险因素以及误用和转移的意外后果。讨论了医生对这些行为的预防、筛查和治疗反应的做法，这些行为是药物不依从性的一种形式，并确定了知识中的差距。OBOT分享了其他国家的经验，这些国家拥有不同的医疗保健系统、公共政策和获得成瘾治疗的机会，以明确世界各地由于许多不同的原因在不同情况下发生的转移和滥用情况，并不局限于丁丙诺啡。与其他已知滥用责任的阿片类药物以及未已知滥用的药物进行比较。其目的是促进对转移和滥用的理解，以便在也认识到成瘾治疗的好处的框架内，能够认识到影响其表达的所有因素(患者和提供者的特征以及公共政策)。有了这一全面的视角，进一步的仔细工作可以帮助确定如何在不侵蚀通过改进成瘾治疗途径和扩展实现的现有好处的情况下将这些行为降至最低。
Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy (OBOT) has rapidly expanded in the United States and abroad, and, with this increase in medication availability, there have been increasing concerns about its diversion, misuse and related harms. This narrative review defines the behaviors of diversion and misuse, examines how the pharmacology of buprenorphine alone and in combination with naloxone influence its abuse liability, and describes the epidemiological data on buprenorphine diversion and intravenous misuse, risk factors for its intravenous misuse and the unintended consequences of misuse and diversion. Physician practices to prevent, screen for, and therapeutically respond to these behaviors, which are a form of medication non-adherence, are discussed and gaps in knowledge are identified. OBOT experiences from other countries that have varied health care systems, public policies, and access to addiction treatment are shared in order to make clear that diversion and misuse occur across the world in various contexts, for many different reasons, and are not limited to buprenorphine. Comparisons are made with other opioids with known abuse liability as well as medications with no known abuse. The objective is to facilitate understanding of diversion and misuse so that all factors influencing their expression (patient and provider characteristics and public policy) can be appreciated within a framework that also recognizes the benefits of addiction treatment. With this comprehensive perspective, further careful work can help determine how to minimize these behaviors without eroding the current benefits realized through improved addiction treatment access and expansion.