Zacny James, Bigelow George, Compton Peggy, Foley Kathleen, Iguchi Martin, Sannerud Christine
Department of Anesthesia and Critical Care, University of Chicago, Box MC4028, 5841 S Maryland Avenue, Chicago, IL 60637, USA.
Drug Alcohol Depend. 2003 Apr 1;69(3):215-32. doi: 10.1016/s0376-8716(03)00003-6.
This position paper from the College on Problems of Drug Dependence addresses the issues related to non-medical use and abuse of prescription opioids. A central theme throughout is the need to strike a balance between risk management strategies to prevent and deter prescription opioid abuse and the need for physicians and patients to have appropriate access to opioid pharmaceuticals for the treatment of pain. The epidemiology of prescription opioid use and abuse is reviewed. Non-medical use and abuse of prescription opioids are on the rise in the United States, illicit use of several widely prescribed opioids has increased disproportionately more than illicit use, and the prevalence of prescription opioid abuse appears to be similar to that of heroin and cocaine abuse. There is a paucity of abuse liability testing of prescription opioids, and methods should be developed to fill critical gaps in our knowledge in this area. The role of regulatory agencies in preventing diversion of prescription opioids and identifying potential sources of diversion are discussed. More research is needed to identify those populations most at risk for abusing prescription opioids, and then to develop appropriately targeted prevention programs. Treatment options are discussed; these depend on whether or not an abuser is in pain. Prescription opioid abuse has harmful ramifications for the legitimate and appropriate use of opioids, including stigmatization, opiophobia, and undertreatment of pain. Recommended steps to take include further epidemiological research, laboratory testing of prescription opioids to determine abuse liability, and clinical trials to determine the efficacy of different approaches to the prevention and treatment of prescription opioid abuse.
药物依赖问题学会的这份立场文件探讨了与处方阿片类药物非医疗使用及滥用相关的问题。贯穿始终的一个核心主题是，需要在预防和遏制处方阿片类药物滥用的风险管理策略与医生和患者为治疗疼痛而适当获取阿片类药物的需求之间取得平衡。本文回顾了处方阿片类药物使用及滥用的流行病学情况。在美国，处方阿片类药物的非医疗使用及滥用呈上升趋势，几种广泛开具的阿片类药物的非法使用增长比例超过了非法药物的总体增长比例，而且处方阿片类药物滥用的流行率似乎与海洛因和可卡因滥用的流行率相似。对处方阿片类药物的滥用可能性测试较少，应开发相关方法以填补我们在这一领域知识的关键空白。文中讨论了监管机构在防止处方阿片类药物转移及识别潜在转移源头方面的作用。需要开展更多研究以确定那些滥用处方阿片类药物风险最高的人群，进而制定针对性强的预防项目。文中还讨论了治疗方案；这些方案取决于滥用者是否处于疼痛状态。处方阿片类药物滥用对阿片类药物的合法及适当使用产生有害影响，包括污名化、阿片恐惧症以及疼痛治疗不足。建议采取的措施包括进一步开展流行病学研究、对处方阿片类药物进行实验室测试以确定其滥用可能性，以及开展临床试验以确定不同预防和治疗处方阿片类药物滥用方法的疗效。
