Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction
Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction
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DOI：
10.1097/adm.0b013e3182312983
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发表时间：
2011-12-01
影响因子：
5.5
通讯作者：
Wyatt, Stephen A.
中科院分区：
文献类型：
--
作者：
Kraus, Mark L.;Alford, Daniel P.;Wyatt, Stephen A.
目的：阿片成瘾在美国影响着200多万患者。丁丙诺啡的出现和2000年《药物成瘾治疗法》的通过使医生能够实施办公室阿片类药物治疗(OBOT)，从而使患者更容易获得治疗，从而使阿片类药物治疗系统发生了革命性的变化。这个共识小组的目的是综合关于丁丙诺啡在办公室环境中使用的最新证据，并提出建议，使更多的医生能够开始治疗阿片成瘾患者。方法：使用PubMed搜索引擎搜索2000年至2009年发表的文献，在同行评议期刊上发表超过375篇文章，其中包括一些发表的指南。这些文章被提交给一个由研究人员、教育工作者和临床医生组成的共识小组，他们是成瘾医学领域的领导者，在OBOT的使用方面具有特定的专业知识。结果：在文献综述和共识讨论的基础上，专家小组就丁丙诺啡在办公室阿片类药物成瘾治疗中的应用提出了一系列的研究结果、结论和建议。结论：丁丙诺啡办公室治疗的患者与美沙酮治疗患者的疗效基本相当。丁丙诺啡的使用几乎没有绝对禁忌症，尽管治疗医生的经验和技能水平可能有很大差异，获得治疗合并疾病或精神疾病所需的资源也可能不同--所有这些都会影响结果。重要的是对每个患者进行有针对性的评估，以确认提供者拥有满足患者需求的可用资源。除了阿片类药物的使用和成瘾外，患者还应接受广泛的生物心理社会需求评估，并应接受治疗、转介或两者兼而有之，以帮助满足他们的所有护理需求，包括医疗、精神护理和社会援助。目前的文献显示丁丙诺啡有良好的疗效，但进一步的研究将继续证明其对特殊人群的有效性，如青少年、孕妇和其他脆弱人群。自本综述以来，几项新的研究提供了新的数据，以继续提高我们对丁丙诺啡对特殊患者群体的安全性和有效性的理解。
Objectives: Opioid addiction affects over 2 million patients in the United States. The advent of buprenorphine and the passage of the Drug Addiction Treatment Act in 2000 have revolutionized the opioid treatment delivery system by granting physicians the ability to administer office-based opioid treatment (OBOT), thereby giving patients greater access to treatment. The purpose of this consensus panel was to synthesize the most current evidence on the use of buprenorphine in the office-based setting and to make recommendations that will enable and allow additional physicians to begin to treat opioid-addicted individuals.Methods: Literature published from 2000 to 2009 was searched using the PubMed search engine and yielded over 375 articles published in peer-reviewed journals, including some that were published guidelines. These articles were submitted to a consensus panel composed of researchers, educators, and clinicians who are leaders in the field of addiction medicine with specific expertise in the use of OBOT. The panel discussed results and agreed upon consensus recommendations for several facets of OBOT.Results: On the basis of the literature review and consensus discussions, the panel developed a series of findings, conclusions, and recommendations regarding the use of buprenorphine in office-based treatment of opioid addiction.Conclusions: Therapeutic outcomes for patients who self-select office-based treatment with buprenorphine are essentially comparable to those seen in patients treated with methadone programs. There are few absolute contraindications to the use of buprenorphine, although the experience and skill levels of treating physicians can vary considerably, as can access to the resources needed to treat comorbid medical or psychiatric conditions-all of which affect outcomes. It is important to conduct a targeted assessment of every patient to confirm that the provider has resources available to meet the patient's needs. Patients should be assessed for a broad array of biopsychosocial needs in addition to opioid use and addiction, and should be treated, referred, or both for help in meeting all their care needs, including medical care, psychiatric care, and social assistance. Current literature demonstrates promising efficacy of buprenorphine, though further research will continue to demonstrate its effectiveness for special populations, such as adolescents, pregnant women, and other vulnerable populations. Since the time of this review, several new studies have provided new data to continue to improve our understanding of the safety and efficacy of buprenorphine for special patient populations.