Bouley M, Viriot E, Barache D
Hôpital Avicenne, Département de Pharmacologie-Toxicologie Biologique, Bobigny, France.
Therapie. 2000 Mar-Apr;55(2):295-301.
The drugs most diverted for toxicomanic use from their therapeutic indication are principally the opioids or related substances, with codeine still high in importance, in spite of the wide prescription of substitution treatments. The psychotropic drugs, essentially the benzodiazepines and the stimulant antidepressants such as amineptine, are also frequently used. The market withdrawal of amineptine should diminish its misuse. The abuse of amphetamines-anorectics and barbiturates seems to be regressing. Nevertheless, substances such as nitrous oxide and ketamine are the subject of selective, recent misuse. Moreover high-dose buprenorphine misuse, as a concomitant buprenorphine-benzodiazepine combination and/or an intravenous injection of high doses of buprenorphine, can be implicated in severe adverse effects. Twenty-one lethal intoxications linked to such drug misuse have already been reported. However, the addictive drug potential is not the only explanation for drugs diverted for toxicomanic use. It is also associated with a polytoxicomania, a symptom of pre-existing difficulties, particularly familial, social and environmental in origin. Therefore, the therapeutic regime should be adapted to the drug addict's personality. We report a few cases of polydrug abusers, treated with methadone in a specialist unit. The misuse and the practical therapeutic response, adapted to each case, are compared and discussed in respect of the data published in the literature.
从其治疗适应症转向用于毒瘾性使用的药物主要是阿片类药物或相关物质，尽管替代疗法处方广泛，但可待因的重要性仍然很高。精神药物，主要是苯二氮䓬类药物和刺激性抗抑郁药如安非他明，也经常被使用。安非他明的退市应会减少其滥用情况。苯丙胺类食欲抑制剂和巴比妥类药物的滥用似乎在减少。然而，一氧化二氮和氯胺酮等物质是近期选择性滥用的对象。此外，高剂量丁丙诺啡的滥用，如丁丙诺啡 - 苯二氮䓬类药物的联合使用和/或静脉注射高剂量丁丙诺啡，可能会导致严重不良反应。已经报告了21例与此类药物滥用相关的致命中毒事件。然而，成瘾药物的潜力并不是转向用于毒瘾性使用的药物的唯一解释。它还与多药滥用有关，这是一种先前存在的困难的症状，特别是源于家庭、社会和环境方面。因此，治疗方案应根据吸毒者的个性进行调整。我们报告了几例在专科单位接受美沙酮治疗的多药滥用者病例。根据文献中发表的数据，对每种情况的滥用情况和实际治疗反应进行了比较和讨论。
