Missed opportunities to test the neuropsychiatric safety--and efficacy--of varenicline among smokers with substance use disorders.
Missed opportunities to test the neuropsychiatric safety--and efficacy--of varenicline among smokers with substance use disorders.
复制标题
错过了在患有药物滥用障碍的吸烟者中测试伐尼克兰的神经精神安全性和有效性的机会。
DOI：
10.1016/j.drugalcdep.2018.02.001
复制
发表时间：
2018
影响因子：
4.2
通讯作者：
Arnsten,JuliaH
中科院分区：
文献类型：
--
作者：
Nahvi,Shadi;Arnsten,JuliaH
烟草控制的成果并未得到普遍分享。尽管美国的烟草使用率总体上在下降，但仍有15%的美国成年人（3600万人）继续吸烟（Jamal et al., 2016）。烟草使用的负担不成比例地集中在特定人群中，包括物质使用障碍患者。在接受SUD治疗的个体中，超过75%的人吸烟（Guydish等人，2011），患有SUD的吸烟者面临着不成比例的烟草相关疾病和死亡负担（Aldridge等人，2017;Apollonio, 2016； Hurt等人，1996）。此外，与不吸烟者相比，处于康复期的SUD吸烟者复发的风险更高（Weinberger等人，2017）。如果不确定和实施有效的烟草治疗干预措施，患有SUD的吸烟者可能会进入治疗，实现康复，并仍有因烟草相关原因复发或死亡的风险。尽管烟草使用有明显的负担，但指导SUD患者戒烟治疗的证据基础有限。虽然，在没有SUD的吸烟者中，伐尼克兰比安非他酮、尼古丁替代单一疗法或安慰剂更有效地戒烟，但早期的伐尼克兰试验排除了患有SUD的吸烟者。病例报告和FDA关于伐尼克兰潜在神经精神风险的黑框警告增加了伐尼克兰在SUD患者中的安全性问题。
Tobacco control gains have not been universally shared. Though tobacco use prevalence in the US is declining overall, 15% of US adults (36 million people) continue to smoke (Jamal et al., 2016). The burden of tobacco use is disproportionately concentrated in select populations, including persons with substance use disorder (SUD). Over 75% of individuals in treatment for SUD smoke cigarettes (Guydish et al., 2011) and smokers with SUD face a disproportionate burden of tobacco-related disease and death (Aldridge et al., 2017; Apollonio, 2016; Hurt et al., 1996). Additionally, smokers with SUD who are in recovery have an increased risk of relapse, compared to non-smokers (Weinberger et al., 2017). Without identification and implementation of efficacious tobacco treatment interventions, smokers with SUD may enter treatment, achieve recovery, and remain at risk for relapse or death from tobacco-related causes.Despite this marked burden of tobacco use, there is a limited evidence base to guide smoking cessation treatment among persons with SUD. Though, among smokers without SUD, varenicline is more efficacious for smoking cessation than bupropion, nicotine replacement monotherapy, or placebo, early varenicline trials excluded smokers with SUD. Case reports and the FDA boxed warning of neuropsychiatric risk potential of varenicline added additional questions about varenicline safety among persons with SUD.