Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
Pain Med. 2010 Jul;11(7):1078-91. doi: 10.1111/j.1526-4637.2010.00877.x. Epub 2010 Jun 8.
There have been recent increases in the use of methadone and buprenorphine in the United States. Methadone is increasingly being used for pain management, and buprenorphine use has expanded to include treatment for opioid addiction, leading to exposures of these drugs in new populations. There is a debate about the relative safety of these two drugs in routine outpatient medical use.
Data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Programs were used to analyze rates of abuse, misuse, and diversion using the Drug Diversion, Key Informant, Poison Center and Opioid Treatment Programs, 2003-2007. National rate and rate ratios were calculated using population and person-time exposed denominators. Detailed data are presented on severity of medical outcome and drug formulations.
Between 2003 and 2007, there were steady increases in the rates of abuse, misuse, and diversion of both methadone and buprenorphine. Rate ratios (per 100,000 population per quarter) of abuse, misuse, and diversion were consistently higher for methadone than buprenorphine. RADARS System poison centers received 7,476 calls for methadone and 1,117 calls for buprenorphine. After accounting for availability, there were higher rates of calls for methadone misuse, abuse, and diversion than buprenorphine in three of the four programs. The numbers of exposures requiring medical attention correspond to 46.8% and 25.8% of all calls, for methadone and buprenorphine, respectively. The most commonly diverted form of methadone was solid oral tablets (which are typically dispensed at pharmacies, not at opioid treatment programs), comprising 73% of cases.
Buprenorphine appears to have a better safety profile than methadone during routine outpatient medical use. However, both medications have roles in the treatment of pain and opioid addiction, and further research into their respective benefits and risks should be conducted.
近年来，美国使用美沙酮和丁丙诺啡的情况有所增加。美沙酮越来越多地用于疼痛管理，丁丙诺啡的使用范围扩大到包括治疗阿片类药物成瘾，导致这些药物在新人群中暴露。关于这两种药物在常规门诊医疗使用中的相对安全性存在争议。
使用研究性滥用、转移和成瘾相关监测系统（RADARS）计划的数据，分析 2003-2007 年药物转移、关键知情人、中毒控制中心和阿片类药物治疗计划滥用、误用和转移率。使用暴露人口和暴露人时作为分母计算全国率和率比。详细数据介绍了医疗结果的严重程度和药物制剂。
2003 年至 2007 年间，美沙酮和丁丙诺啡的滥用、误用和转移率稳步上升。滥用、误用和转移的率比（每 10 万人每季度）均高于丁丙诺啡。RADARS 系统中毒控制中心收到了 7476 次美沙酮和 1117 次丁丙诺啡的电话。在考虑到可获得性后，在四个计划中的三个计划中，美沙酮的误用、滥用和转移率高于丁丙诺啡。需要医疗关注的暴露人数分别占美沙酮和丁丙诺啡所有电话的 46.8%和 25.8%。美沙酮最常被转移的形式是固体口服片剂（通常在药房而不是阿片类药物治疗计划中配药），占 73%。
在常规门诊医疗使用中，丁丙诺啡的安全性似乎优于美沙酮。然而，这两种药物在治疗疼痛和阿片类药物成瘾方面都有作用，应该对它们各自的益处和风险进行进一步研究。
