O'Shea Jacinta, Law Fergus, Melichar Jan
Avon and Wessex Deanery, Avon and Wiltshire NHS Mental Health Partnership, Bristol, UK.
BMJ Clin Evid. 2009 Jul 24;2009:1015.
Dependence on opioids is a multifactorial condition involving genetic and psychosocial factors. There are three approaches to treating opioid dependence. Stabilisation is usually by opioid substitution treatments, and aims to ensure that the drug use becomes independent of mental state (such as craving and mood) and independent of circumstances (such as finance and physical location). The next stage is to withdraw (detox) from opioids. The final aim is relapse prevention.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for stabilisation (maintenance) in people with opioid dependence? What are the effects of drug treatments for withdrawal in people with opioid dependence? What are the effects of drug treatments for relapse prevention in people with opioid dependence? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: buprenorphine; clonidine; lofexidine; methadone; naltrexone; and ultra-rapid withdrawal regimes.
对阿片类药物的依赖是一种涉及遗传和社会心理因素的多因素状况。治疗阿片类药物依赖有三种方法。稳定阶段通常采用阿片类药物替代疗法，旨在确保药物使用不受精神状态（如渴望和情绪）影响，也不受环境因素（如经济状况和地理位置）影响。下一阶段是从阿片类药物中撤药（戒毒）。最终目标是预防复发。
我们进行了一项系统评价，旨在回答以下临床问题：药物治疗对阿片类药物依赖者进行稳定（维持）治疗的效果如何？药物治疗对阿片类药物依赖者进行撤药治疗的效果如何？药物治疗对阿片类药物依赖者预防复发的效果如何？我们检索了：截至2008年5月的Medline、Embase、Cochrane图书馆及其他重要数据库（Clinical Evidence综述会定期更新；请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品与保健品监管局（MHRA）等相关组织的危害警示。
我们发现了23项符合我们纳入标准的系统评价、随机对照试验或观察性研究。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们提供了以下干预措施有效性和安全性的相关信息：丁丙诺啡；可乐定；洛非西定；美沙酮；纳曲酮；以及超快速撤药方案。
