Consensus statement on office-based treatment of opioid dependence using buprenorphine
Consensus statement on office-based treatment of opioid dependence using buprenorphine
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DOI：
10.1016/j.jsat.2004.06.005
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发表时间：
2004-09-01
影响因子：
3.9
通讯作者：
Kosten, TR
中科院分区：
文献类型：
--
作者：
Fiellin, DA;Kleber, H;Kosten, TR
丁丙诺啡和丁丙诺啡/纳洛酮（BUP）是新批准用于阿片类药物依赖的基于办公室的治疗。联邦和非联邦监管和监测机构、国家和国际研究人员、国家专业组织、参与监测的研究人员、阿片类药物治疗计划和制药行业开会，以综合和传播实用信息，指导这些药物的培训、实践、监测、监管和评估工作。我们对文献、培训课程和实践指南进行了回顾，并委托撰写了描述最近完成或仍在进行中的BUP治疗研究或现场经验的手稿。协商一致进程产生了15项声明：（1）联邦政府应收集阿片类药物相关死亡和发病率的基线数据，以评估BUP对公共卫生的影响，（2）团体实践的患者限制应适用于个体医生，而不是团体实践，（3和4）需要电话和基于互联网的医生和药剂师支持，（5）应告知为阿片类药物依赖患者提供心理社会服务的临床医生BUP的作用，（6）应指导阿片类药物依赖患者在轻度戒断时进行诱导，（7）现有的药物滥用治疗中心指南提供了合理的诱导方案，（8）医生应准备使用辅助药物与BUP诱导，（9）在诱导期间必须有医生或护士可供患者使用，（10）同时咨询和支持服务是必要的，（11）没有适当的后续成瘾治疗的解毒导致快速复发，并且不如维持有效，（12）妊娠的阿片类药物依赖妇女应使用良好的临床实践进行治疗，包括专家成瘾护理和产前护理，（13）BUP诱导和戒断治疗可受益于不同的付款指定，（14）带回家的药物选择应根据患者的需要量身定制，（15）需要对独特的患者群体进行临床和政策研究。(C)2004爱思唯尔公司All rights reserved.
Buprenorphine and buprenorphine/naloxone (BUP) are newly approved for office-based treatment of opioid dependence. Federal and non-federal regulatory and monitoring agencies, national and international researchers, national professional organizations, researchers involved in monitoring, opioid treatment programs and the pharmaceutical industry met to synthesize and disseminate practical information to guide training, practice, monitoring, regulation and evaluation efforts with these medications. We performed a review of the literature, training curricula and practice guidelines and commissioned manuscripts describing recently completed, or still in progress, studies or field experiences with BUP treatment. A consensus process generated fifteen statements: (1) The federal government should collect baseline data on opioid-related deaths and morbidity to assess the effect of BUP on public health, (2) the patient limit for group practices should apply to individual physicians rather than group practices, (3 and 4) telephone and Internet-based physician and pharmacist support is needed, (5) clinicians who provide psychosocial services to opioid dependent patients should be informed of the role of BUP, (6) opioid-dependent patients should be instructed to present for induction in mild withdrawal, (7) the existing Center for Substance Abuse Treatment guidelines provide a reasonable induction protocol, (8) physicians should be prepared to use ancillary medications with BUP induction, (9) a physician or nurse must be available to the patient during the induction period, (10) concurrent counseling and support services are necessary, (11) detoxification without appropriate followup addiction treatment leads to rapid relapse and is not as effective as maintenance, (12) pregnant opioid-dependent women should be treated using good clinical practice including specialist addiction care and prenatal care, (13) BUP induction and withdrawal treatment may benefit from different designations for payment, (14) take-home medication options should be tailored to patients' needs, (15) there is a need for clinical and policy research in unique patient populations. (C) 2004 Elsevier Inc. All rights reserved.