Maintenance medication for opiate addiction: the foundation of recovery.
Maintenance medication for opiate addiction: the foundation of recovery.
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DOI：
10.1080/10550887.2012.694598
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发表时间：
2012
影响因子：
2.3
通讯作者：
Bart G
中科院分区：
文献类型：
--
作者：
Bart G
非法使用阿片剂是美国增长最快的药物使用问题，也是全世界寻求非法药物使用成瘾治疗服务的主要原因。它与HIV、丙型肝炎和药物过量相关的显著发病率和死亡率相关。阿片类药物成瘾的治疗需要长期管理。单靠行为干预的结果非常糟糕，超过80%的患者重新吸毒。同样，药物辅助戒毒的效果也很差。本文提供了FDA批准用于长期治疗阿片类药物依赖的三种药物的局部综述：阿片类激动剂美沙酮，阿片类部分激动剂丁丙诺啡和阿片类拮抗剂纳洛酮。描述了每种药物的基本作用机制和治疗结果。结果表明，维持药物治疗为患者提供了从阿片类药物成瘾中恢复的最佳机会。大量文献和系统综述表明，美沙酮或丁丙诺啡维持治疗与治疗保留、减少非法阿片类药物使用、减少渴望和改善社会功能相关。口服纳洛酮在治疗阿片类药物成瘾方面无效，但最近使用缓释纳洛酮注射剂的研究显示出希望。虽然缓释纳洛酮注射剂与美沙酮或丁丙诺啡之间没有直接比较，但保留的间接比较显示，与美沙酮和丁丙诺啡相比，结果较差。需要进一步的工作来直接比较每种药物，并确定有助于药物选择的个体因素。在此之前，药物的选择应基于对每种药物的结果、风险和益处进行讨论后的知情选择。
Illicit use of opiates is the fastest growing substance use problem in the United States and the main reason for seeking addiction treatment services for illicit drug use throughout the world. It is associated with significant morbidity and mortality related to HIV, hepatitis C, and overdose. Treatment for opiate addiction requires long-term management. Behavioral interventions alone have extremely poor outcomes, with more than 80% of patients returning to drug use. Similarly poor results are seen with medication assisted detoxification. This article provides a topical review of the three medications approved by the FDA for long-term treatment of opiate dependence: the opioid agonist methadone, the opioid partial agonist buprenorphine, and the opioid antagonist naltrexone. Basic mechanisms of action and treatment outcomes are described for each medication. Results indicate that maintenance medication provides the best opportunity for patients to achieve recovery from opiate addiction. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function. Oral naltrexone is ineffective in treating opiate addiction but recent studies using extended release naltrexone injections have shown promise. While no direct comparisons between extended release naltrexone injections and either methadone or buprenorphine exist, indirect comparison of retention shows inferior outcome compared to methadone and buprenorphine. Further work is needed to compare directly each medication and determine individual factors that can assist in medication selection. Until such time, selection of medication should be based on informed choice following a discussion of outcomes, risks, and benefits of each medication.