American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.
American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.
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DOI：
10.1097/adm.0000000000000166
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发表时间：
2015-09
影响因子：
5.5
通讯作者：
Jarvis M
中科院分区：
文献类型：
--
作者：
Kampman K;Jarvis M
疾病控制中心近期将阿片类药物的使用及由此导致的死亡描述为一种流行病。在当前，在大多数医疗实践模式中，基层医疗医生通常不具备使用药物妥善治疗这种疾病所需的技能和时间。不理想的治疗可能导致了该流行病的蔓延以及对不道德行为的担忧。同时，由于很少有医生愿意且能够提供有效的治疗，获得有效治疗的途径受到极大限制。制定本《实践指南》是为了协助对阿片类药物使用障碍进行评估和治疗，并希望借助这一工具，更多的医生能够提供有效的治疗。尽管已有针对阿片类药物使用障碍治疗的指南，但都没有涵盖目前用于治疗该疾病的所有药物。此外，现有的指南很少涉及特殊人群的需求，比如孕妇、伴有精神疾病的个体、疼痛患者、青少年或涉及刑事司法系统的个体。本实践指南是采用兰德公司（RAND）/加利福尼亚大学洛杉矶分校（UCLA）适宜性方法（RAM）制定的——这是一个将科学证据和临床知识相结合以确定一系列临床操作适宜性的过程。RAM是一种审慎的方法，包括对现有指南的审查、文献综述、适宜性评级、必要性审查以及文件制定。在这个项目中，美国成瘾医学协会挑选了一个独立委员会来监督指南的制定并协助撰写。美国成瘾医学协会的质量改进委员会监督了独立制定委员会的选拔过程。指南中的建议涵盖了广泛的主题，从患者的初始评估、药物的选择、阿片类药物使用障碍所有获批药物的使用、将心理社会治疗与药物治疗相结合、特殊人群的治疗，到使用纳洛酮治疗阿片类药物过量。同时也指出了需要进一步研究的主题。
The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This “Practice Guideline” was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) – a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted.