Group Health Research Institute, Seattle, Washington 98101, USA.
Ann Intern Med. 2011 Sep 6;155(5):325-8. doi: 10.7326/0003-4819-155-5-201109060-00011.
In the past 20 years, primary care physicians have greatly increased prescribing of long-term opioid therapy. However, the rise in opioid prescribing has outpaced the evidence regarding this practice. Increased opioid availability has been accompanied by an epidemic of opioid abuse and overdose. The rate of opioid addiction among patients receiving long-term opioid therapy remains unclear, but research suggests that opioid misuse is not rare. Recent studies report increased risks for serious adverse events, including fractures, cardiovascular events, and bowel obstruction, although further research on medical risks is needed. New data indicate that opioid-related risks may increase with dose. From a societal perspective, higher-dose regimens account for the majority of opioids dispensed, so cautious dosing may reduce both diversion potential and patient risks for adverse effects. Limiting long-term opioid therapy to patients for whom it provides decisive benefits could also reduce risks. Given the warning signs and knowledge gaps, greater caution and selectivity are needed in prescribing long-term opioid therapy. Until stronger evidence becomes available, clinicians should err on the side of caution when considering this treatment.
在过去的 20 年中，初级保健医生大大增加了长期阿片类药物治疗的处方量。然而，阿片类药物的使用量增加速度超过了这一实践的证据。阿片类药物的供应增加伴随着阿片类药物滥用和过量用药的流行。接受长期阿片类药物治疗的患者的阿片类药物成瘾率尚不清楚，但研究表明，阿片类药物滥用并不罕见。最近的研究报告称，严重不良事件的风险增加，包括骨折、心血管事件和肠梗阻，尽管还需要进一步研究医学风险。新数据表明，阿片类药物相关的风险可能随剂量增加而增加。从社会角度来看，高剂量方案占发放的阿片类药物的大部分，因此谨慎用药可能会降低滥用的可能性和患者不良反应的风险。将长期阿片类药物治疗限制在能从中获得显著获益的患者，也可以降低风险。鉴于这些警示信号和知识空白，开具长期阿片类药物治疗的处方时需要更加谨慎和慎重。在有更强有力的证据之前，临床医生在考虑这种治疗方法时应持谨慎态度。
