Opioid Analgesics and Nicotine: More Than Blowing Smoke.
Opioid Analgesics and Nicotine: More Than Blowing Smoke.
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DOI：
10.3109/15360288.2015.1063559
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发表时间：
2015-09-01
影响因子：
1.1
通讯作者：
Weaver, Michael F
中科院分区：
文献类型：
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作者：
Yoon, Jin H;Lane, Scott D;Weaver, Michael F
从业者很可能遇到同时使用尼古丁产品和阿片类镇痛药的患者。吸烟者会出现更严重、更持久的慢性疼痛，并且使用处方阿片类药物的频率更高。目前吸烟是处方阿片类药物非医疗使用风险的有力预测因素。阿片类药物和烟碱胆碱能神经递质系统以重要方式相互作用，以调节阿片类药物和尼古丁的作用：尼古丁诱导的多巴胺释放依赖于阿片类药物系统的促进，而烟碱乙酰胆碱系统调节几类滥用药物（包括阿片类药物）的自我给药。尼古丁可以作为使用其他药物的启动剂，在阿片类药物系统的情况下可能是双向的。阿片类药物和烟草中的化合物（包括尼古丁）由细胞色素 P450 酶系统代谢，但阿片类药物和烟草产品的代谢可能很复杂。因此，药物相互作用是可能的，但并不总是很清楚。由于这些问题，建议询问服用阿片类药物止痛的患者是否使用尼古丁。在评估患者烟草使用情况时，从业人员还应获取除香烟以外的其他产品的信息，例如雪茄、烟斗、无烟烟草和电子尼古丁输送系统（ENDS或电子烟）。有多种形式的行为疗法和药物疗法可帮助患者戒烟，阿片类激动剂维持和疼痛诊所代表了尼古丁干预计划未充分利用的机会。
Practitioners are highly likely to encounter patients with concurrent use of nicotine products and opioid analgesics. Smokers present with more severe and extended chronic pain outcomes and have a higher frequency of prescription opioid use. Current tobacco smoking is a strong predictor of risk for nonmedical use of prescription opioids. Opioid and nicotinic-cholinergic neurotransmitter systems interact in important ways to modulate opioid and nicotine effects: dopamine release induced by nicotine is dependent on facilitation by the opioid system, and the nicotinic-acetylcholine system modulates self-administration of several classes of abused drugs-including opioids. Nicotine can serve as a prime for the use of other drugs, whichin the case of the opioid system may be bidirectional.Opioids and compounds in tobacco, including nicotine, are metabolized by the cytochrome P450 enzyme system, but the metabolism of opioids and tobacco products can be complicated. Accordingly, drug interactions are possible but not always clear. Because of these issues, asking about nicotine use in patients taking opioids for pain is recommended. When assessing patient tobacco use, practitioners should also obtain information on products other than cigarettes, such as cigars, pipes, smokeless tobacco, and electronic nicotine delivery systems (ENDS, or e-cigarettes). There are multiple forms of behavioral therapy and pharmacotherapy available to assist patients with smoking cessation, and opioid agonist maintenance and pain clinics represent underutilized opportunities for nicotine intervention programs.