Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany.
World J Biol Psychiatry. 2011 Apr;12(3):160-87. doi: 10.3109/15622975.2011.561872.
To develop evidence-based practice guidelines for the pharmacological treatment of opioid abuse and dependence.
An international task force of the World Federation of Societies of Biological Psychiatry (WFSBP) developed these practice guidelines after a systematic review of the available evidence pertaining to the treatment of opioid dependence. On the basis of the evidence, the Task Force reached a consensus on practice recommendations, which are intended to be clinically and scientifically meaningful for physicians who treat adults with opioid dependence. The data used to develop these guidelines were extracted primarily from national treatment guidelines for opioid use disorders, as well as from meta-analyses, reviews, and publications of randomized clinical trials on the efficacy of pharmacological and other biological treatments for these disorders. Publications were identified by searching the MEDLINE database and the Cochrane Library. The literature was evaluated with respect to the strength of evidence for efficacy, which was categorized into one of six levels (A-F).
There is an excellent evidence base supporting the efficacy of methadone and buprenorphine or the combination of buprenorphine and naloxone for the treatment of opioid withdrawal, with clonidine and lofexidine as secondary or adjunctive medications. Opioid maintenance with methadone and buprenorphine is the best-studied and most effective treatment for opioid dependence, with heroin and naltrexone as second-line medications.
There is enough high quality data to formulate evidence-based guidelines for the treatment of opioid abuse and dependence. This task force report provides evidence for the efficacy of a number of medications to treat opioid abuse and dependence, particularly the opioid agonists methadone or buprenorphine. These medications have great relevance for clinical practice.
制定基于循证医学的阿片类药物滥用和依赖的药物治疗指南。
世界生物精神病学联合会（WFSBP）的一个国际工作组在对治疗阿片类药物依赖的现有证据进行系统回顾后，制定了这些实践指南。根据证据，工作组就实践建议达成共识，这些建议旨在为治疗阿片类药物依赖的医生提供临床和科学意义。用于制定这些指南的数据主要来自国家阿片类药物使用障碍治疗指南，以及关于这些疾病药物和其他生物治疗疗效的荟萃分析、综述和随机临床试验出版物。通过搜索 MEDLINE 数据库和 Cochrane 图书馆来确定出版物。文献的评估主要是基于疗效的证据强度，分为六个等级之一（A-F）。
有大量的证据支持美沙酮和丁丙诺啡或丁丙诺啡和纳洛酮联合治疗阿片类药物戒断，可乐定和洛非西定是二线或辅助药物。美沙酮和丁丙诺啡的阿片类药物维持治疗是治疗阿片类药物依赖最有研究和最有效的治疗方法，海洛因和纳曲酮是二线药物。
有足够高质量的数据来制定治疗阿片类药物滥用和依赖的循证指南。本专题工作组报告提供了一些药物治疗阿片类药物滥用和依赖的疗效证据，特别是阿片类激动剂美沙酮或丁丙诺啡。这些药物对临床实践具有重要意义。
