National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Drug Alcohol Rev. 2011 May;30(3):246-54. doi: 10.1111/j.1465-3362.2011.00304.x.
To provide an overview of the availability of pharmaceutical opioids and the evidence on the extent of diversion and injection in South Asia.
This paper reviews existing peer-reviewed and 'grey' literature on the extramedical use and injection of pharmaceutical opioids in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka.
Reports indicate that prescribing for all types of pain is inadequate. There is a paucity of empirical data across South Asia regarding the mechanisms and extent of the diversion and misuse of pharmaceutical opioids, although the problem is widely acknowledged. India is believed to account for significant large-scale diversion within the region and further afield through poor regulation of licit opioid production and pharmacies. A recent decline in use of natural opiates has been accompanied by an increase in pharmaceutical opioid misuse and increasingly, injection, particularly in Bangladesh, India, Nepal and Pakistan. The medications are typically buprenorphine preparations and/or other lower potency opioids, such as codeine, nalbuphine and dextropropoxyphene. Opioid substitution treatment and needle-syringe programs are available in some countries, but better coverage is needed. Studies identify a lack of comprehensive knowledge regarding HIV and high prevalence of risk behaviours among at-risk populations in the region.
It is imperative for the region to rapidly facilitate access to opioids for the treatment of pain and opioid dependence, ensuring effective systems that maintain quality care, regulate and monitor retail pharmacies, and minimise diversion. Prevention of HIV among people who inject pharmaceutical opioids is essential.
概述南亚地区可供药用阿片类药物的情况，以及药物滥用和注射的相关证据。
本文综述了关于阿片类药物在阿富汗、孟加拉国、不丹、印度、马尔代夫、尼泊尔、巴基斯坦和斯里兰卡等南亚国家的非医疗用途和注射的现有同行评议文献和“灰色”文献。
报告显示，各种类型疼痛的处方都不足。尽管该问题广为人知，但整个南亚地区关于药物滥用和药物滥用的机制和程度的数据很少。印度被认为是该地区乃至更远地区大规模药物滥用的主要来源，其原因是对合法阿片类药物生产和药店的监管不善。最近，天然阿片类药物的使用有所减少，同时药物滥用和注射（尤其是在孟加拉国、印度、尼泊尔和巴基斯坦）的情况有所增加。这些药物通常是丁丙诺啡制剂和/或其他低效能阿片类药物，如可待因、纳布啡和右丙氧芬。一些国家提供了阿片类药物替代治疗和针具交换项目，但需要更好的覆盖范围。研究表明，该地区的人们对艾滋病毒的认识不足，高危人群的风险行为普遍存在。
该地区必须迅速促进阿片类药物的获取，以治疗疼痛和阿片类药物依赖，确保建立有效的系统，以维持高质量的护理，管理和监测零售药店，并尽量减少药物滥用。预防注射药用阿片类药物的人感染艾滋病毒至关重要。
