Department of Family Medicine, St Joseph's Health Centre, Toronto, ON M6R 1B5, Canada.
Can Fam Physician. 2011 Mar;57(3):281-9.
To review the use of buprenorphine for opioid-addicted patients in primary care.
The MEDLINE database was searched for literature on buprenorphine from 1980 to 2009. Controlled trials, meta-analyses, and large observational studies were reviewed.
Buprenorphine is a partial opioid agonist that relieves opioid withdrawal symptoms and cravings for 24 hours or longer. Buprenorphine has a much lower risk of overdose than methadone and is preferred for patients at high risk of methadone toxicity, those who might need shorter-term maintenance therapy, and those with limited access to methadone treatment. The initial dose should be given only after the patient is in withdrawal. The therapeutic dose range for most patients is 8 to 16 mg daily. It should be dispensed daily by the pharmacist with gradual introduction of take-home doses. Take-home doses should be introduced more slowly for patients at higher risk of abuse and diversion (eg, injection drug users). Patients who fail buprenorphine treatment should be referred for methadone- or abstinence-based treatment.
Buprenorphine is an effective treatment of opioid addiction and can be safely prescribed by primary care physicians.
综述在初级保健中使用丁丙诺啡治疗阿片成瘾患者的情况。
检索了 1980 年至 2009 年 MEDLINE 数据库中关于丁丙诺啡的文献。对对照试验、荟萃分析和大型观察性研究进行了评价。
丁丙诺啡是一种部分阿片激动剂，可缓解阿片戒断症状和对阿片类药物的渴求长达 24 小时或更长时间。丁丙诺啡的过量用药风险比美沙酮低得多，适用于有发生美沙酮中毒高风险的患者、那些可能需要短期维持治疗的患者，以及那些获得美沙酮治疗机会有限的患者。只有在患者处于戒断状态时才给予初始剂量。大多数患者的治疗剂量范围为每日 8 至 16 毫克。应由药剂师每日配药，并逐渐引入可带回家的剂量。对于有更高滥用和转移风险的患者（例如，注射吸毒者），应更缓慢地引入可带回家的剂量。未能接受丁丙诺啡治疗的患者应转介接受美沙酮或基于戒断的治疗。
丁丙诺啡是阿片类药物成瘾的有效治疗方法，可由初级保健医生安全处方。
