Flugsrud-Breckenridge Marcia R, Gevirtz Clifford, Paul Dennis, Gould Harry J
Department of Neurology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Curr Opin Anaesthesiol. 2007 Aug;20(4):319-24. doi: 10.1097/ACO.0b013e32814b1626.
Chronic pain leads to a reduction in the quality of life for those who suffer it. Due also to high medical costs and lost productivity, chronic pain is a significant burden on society. One contributor to the burden of pain is the fear that medications used in pain management produce dependency, leading to diversion and addiction. Certain medications used in practice, although not abused by the patient, seem to be favored and these are frequently reported to be used recreationally by the nonpatient population. This report identifies medications that most frequently present a problem in pain practices, why they are a problem, and possible alternatives to their use.
Problem medications used in analgesic regimens tend to be those that have rapid onset due to their lipophilic nature or route of administration, short duration, and a sedating or energizing effect. These medications are generally more affordable than alternatives with less abuse potential. These medications are more often covered by insurance and more frequently prescribed. Changes in prescribing habits have resulted in predictable shifts in abuse.
Addiction and diversion of prescription medications is a multidimensional problem. Its multifactorial solution will require efforts at many regulatory levels.
慢性疼痛会降低患者的生活质量。由于高昂的医疗成本和生产力损失，慢性疼痛给社会带来了沉重负担。疼痛负担的一个原因是担心用于疼痛管理的药物会导致依赖，进而引发药物转移和成瘾。在实际应用中，某些药物虽未被患者滥用，但似乎更受青睐，且经常有报道称非患者人群会将其用于消遣。本报告确定了在疼痛治疗中最常出现问题的药物、它们成为问题的原因以及可能的替代用药。
用于镇痛方案的问题药物往往是那些因其亲脂性或给药途径而起效迅速、作用持续时间短且具有镇静或兴奋作用的药物。这些药物通常比滥用可能性较小的替代药物更便宜。这些药物更常被保险覆盖，处方也更频繁。处方习惯的改变导致了滥用情况的可预测变化。
处方药的成瘾和药物转移是一个多层面的问题。其多因素解决方案需要在多个监管层面做出努力。
