Balster Robert L, Bigelow George E
Department of Pharmacology and Toxicology and Institute for Drug and Alcohol Studies, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298-0310, USA.
Drug Alcohol Depend. 2003 Jun 5;70(3 Suppl):S13-40. doi: 10.1016/s0376-8716(03)00097-8.
Regulatory control of drugs with abuse liability is an important component of drug control policy and is believed to help prevent nonmedical use. To be maximally effective, this requires a scientific assessment of abuse liability of drugs considered for regulatory control. These assessments have relied extensively on laboratory-based animal and human testing, but also utilize information from clinical trials, actual abuse and other sources. Here, we discuss recommendations and guidelines that have been proposed for abuse liability assessment and describe important review papers and conference proceedings that have addressed this matter, focusing primarily on drugs with medical usefulness. Historically, there is substantial consensus about how to approach abuse liability evaluation of drugs with actions similar to those of abused opiates, stimulants, depressants, and to a somewhat lesser extent, cannabinoids and hallucinogens, and much of what has been recommended for abuse potential assessment in the past remains valid and useful. On the other hand, novel CNS-active medications which cannot be readily classified with these traditional drugs of abuse are increasingly under development. In addition, advances in the science of abuse liability assessment need to be incorporated into future guidelines and recommendations on this subject. Developers of new medications need guidance on how to utilize scientific research to maximize therapeutic benefit while minimizing risk for abuse. Thus, another goal of this review has been to identify areas where critical thinking and new guideline development are needed.
对具有滥用倾向的药物进行监管控制是药物管制政策的重要组成部分,并且被认为有助于防止非医疗用途。为了达到最大效果,这需要对考虑进行监管控制的药物的滥用倾向进行科学评估。这些评估广泛依赖基于实验室的动物和人体测试,但也利用来自临床试验、实际滥用情况及其他来源的信息。在此,我们讨论针对滥用倾向评估所提出的建议和指南,并描述已探讨此问题的重要综述论文和会议记录,主要聚焦于具有医疗用途的药物。从历史上看,对于如何对作用类似于被滥用的阿片类药物、兴奋剂、抑制剂,以及在一定程度上还有大麻素和致幻剂的药物进行滥用倾向评估,存在大量共识,过去所推荐的许多关于滥用潜力评估的内容仍然有效且有用。另一方面,越来越多正在研发的新型中枢神经系统活性药物无法轻易归类于这些传统滥用药物。此外,滥用倾向评估科学的进展需要纳入关于该主题的未来指南和建议中。新药物开发者需要关于如何利用科学研究来最大化治疗益处同时最小化滥用风险的指导。因此,本综述的另一个目标是确定需要批判性思维和制定新指南的领域。