Webster Lynn, St Marie Barbara, McCarberg Bill, Passik Steven D, Panchal Sunil J, Voth Eric
Lifetree Clinical Research and Pain Clinic, Salt Lake City, Utah, USA.
J Opioid Manag. 2011 May-Jun;7(3):235-45. doi: 10.5055/jom.2011.0066.
Opioids are widely used for the treatment of patients with chronic pain; yet, the increase in their abuse, misuse, and diversion is an ongoing focus of regulatory, governmental, and legal scrutiny. As a consequence, clinicians are faced with numerous challenges in an effort to use opioids in appropriate patients with pain while minimizing the potential for opioid abuse, misuse, and diversion. Policies and programs such as state prescription monitoring programs, which have been in existence for decades, are but one attempt to address some of the issues regarding the prescribing of opioids. Another is a risk evaluation and mitigation strategy for opioids under consideration by the US Food and Drug Administration. At the clinical level, a universal precautions and risk management package that includes risk assessment and patient monitoring is a recommended approach. This approach can also include the use of abuse-deterrent and abuse-resistant formulations designed to reduce the nonmedical use of opioids. Several of these opioid formulations have been approved or should soon be on the market for use in the United States; however, their role and other questions regarding their use remain unanswered. The authors offer their clinical perspective on several of these key questions.
阿片类药物被广泛用于治疗慢性疼痛患者；然而，其滥用、误用及转移的增加一直是监管、政府和法律审查的重点。因此，临床医生在努力为合适的疼痛患者使用阿片类药物的同时，将阿片类药物滥用、误用及转移的可能性降至最低，面临着诸多挑战。诸如州处方监测计划等政策和项目已经存在了数十年，这只是解决阿片类药物处方相关一些问题的一种尝试。另一种是美国食品药品监督管理局正在考虑的阿片类药物风险评估和缓解策略。在临床层面，推荐采用包括风险评估和患者监测在内的通用预防措施和风险管理方案。这种方法还可包括使用旨在减少阿片类药物非医疗用途的抗滥用和抗误用制剂。其中几种阿片类药物制剂已获批准或很快将在美国上市使用；然而，它们的作用以及关于其使用的其他问题仍未得到解答。作者就其中几个关键问题给出了他们的临床观点。
