Potential uses of naltrexone in emergency department patients with opioid use disorder.
Potential uses of naltrexone in emergency department patients with opioid use disorder.
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纳曲酮在急诊科阿片类药物使用障碍患者中的潜在用途。
DOI：
10.1080/15563650.2019.1583342
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Babu,Kavita
中科院分区：
文献类型：
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作者：
Bradley,EvanStuart;Liss,David;Carreiro,StephaniePepper;Brush,DavidEric;Babu,Kavita
导读：尽管广泛认识到阿片类药物危机，阿片类药物过量仍然是急诊科（ED）使用的常见原因。这些患者稳定后的治疗通常包括提供门诊治疗选择的信息。理想情况下，过量服用的急诊科就诊将提供一个立即开始治疗阿片类药物使用障碍（OUD）的机会。尽管美沙酮和丁丙诺啡的阿片类激动剂治疗被广泛认为是有效的，但通常被称为“药物辅助治疗”，但更准确地说是“药物成瘾治疗”（MAT），由于处方者和治疗方案的短缺，即使是有动机的个人也很难获得。此外，阿片类激动剂治疗可能并不适合所有患者，因为许多过量服用后出现的患者并非阿片类药物依赖。需要更多的治疗方案，以成功地匹配不同需求的患者的最佳治疗方案，以避免复发。纳曲酮是一种长效阿片类拮抗剂，可口服或每月肌内注射一次缓释，可能是另一种治疗选择。方法：检索MEDLINE和PubMed的文献。我们的目标是获取与纳曲酮相关的文献，以及纳曲酮与其他用于MAT、阿片类解毒和纳曲酮代谢的药物进行比较的文献。我们最初的搜索逻辑总共返回了618篇文章。在对相关性进行个人评估之后，我们选择了65个进行深入分析。结论：在这里，我们回顾了纳曲酮的药理学，因为它与OUD有关，它的使用历史，并强调了最近的研究和使用该药作为MAT的新方法，包括它在ED就诊后阿片类药物过量的潜在启动。
Introduction:Despite widespread recognition of the opioid crisis, opioid overdose remains a common reason for Emergency Department (ED) utilization. Treatment for these patients after stabilization often involves the provision of information for outpatient treatment options. Ideally, an ED visit for overdose would present an opportunity to start treatment for opioid use disorder (OUD) immediately. Although widely recognized as effective, opioid agonist therapy with methadone and buprenorphine commonly referred to as “medication-assisted therapy” but more correctly as “medication for addiction treatment” (MAT), can be difficult to access even for motivated individuals due to shortages of prescribers and treatment programs. Moreover, opioid agonist therapy may not be appropriate for all patients, as many patients who present after overdose are not opioid dependent. More treatment options are required to successfully match patients with diverse needs to an optimal treatment plan in order to avoid relapse. Naltrexone, a long-acting opioid antagonist, available orally and as a monthly extended-release intramuscular injection, may represent another treatment option.Methods:We conducted a literature search of MEDLINE and PubMed. We aimed to capture references related to naltrexone and is use as MAT for OUD, as well as manuscripts that discussed naltrexone in comparison toother agents used for MAT, opioid detoxification, and naltrexone metabolism. Our initial search logic returned a total of 618 articles. Following individual evaluation for relevance, we selected 65 for in-depthreview. Manuscripts meeting criteria were examined for citations meriting further review, leading to the addition of 30 manuscriptsConclusions:Here, we review the pharmacology of naltrexone as it relates to OUD, its history of use, and highlight recent studies and new approaches for use of the drug as MAT including its potential initiation after ED visit for opioid overdose.