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丁丙诺啡的临床应用进展:在阿片类相关疾病中的应用。

Update on the clinical use of buprenorphine: in opioid-related disorders.

机构信息

Department of Psychiatry, McGill University, Montreal, Que, Canada.

出版信息

Can Fam Physician. 2012 Jan;58(1):37-41.

Abstract

OBJECTIVE

To review the current evidence on buprenorphine-naloxone for the treatment of opioid-related disorders, with a focus on primary care settings.

QUALITY OF EVIDENCE

MEDLINE and the Cochrane Database of Systematic Reviews were searched. Evidence is mainly level I.

MAIN MESSAGE

Buprenorphine is a partial μ-opioid agonist and κ-opioid antagonist with a long half-life and less abuse potential than methadone. For detoxification, buprenorphine is at least equivalent to methadone and is superior to clonidine. For maintenance treatment, buprenorphine is clearly superior to placebo. Methadone has a slight advantage in terms of retention in treatment, but a stepped approach with initial use of buprenorphine-naloxone is as efficacious. Use of buprenorphine in the primary care setting is feasible, safe, and effective. Authorization to prescribe buprenorphine can be obtained after completing online training.

CONCLUSION

Buprenorphine is a safe and effective agent for detoxification from opioids. It can be used as a first-line agent in maintenance programs, owing to its lower abuse potential relative to other opioids. Its effectiveness in primary care settings makes it a useful therapeutic tool for family physicians.

摘要

目的

综述丁丙诺啡-纳洛酮治疗阿片类相关疾病的现有证据,重点关注初级保健环境。

证据质量

检索了 MEDLINE 和 Cochrane 系统评价数据库。证据主要为一级。

主要信息

丁丙诺啡是一种部分μ-阿片受体激动剂和κ-阿片受体拮抗剂,半衰期长,滥用潜力低于美沙酮。用于戒毒,丁丙诺啡至少与美沙酮等效,优于可乐定。用于维持治疗,丁丙诺啡明显优于安慰剂。美沙酮在治疗保留方面略有优势,但采用丁丙诺啡-纳洛酮初始使用的阶梯方法同样有效。在初级保健环境中使用丁丙诺啡是可行的、安全的和有效的。在线培训完成后,即可获得开具丁丙诺啡的授权。

结论

丁丙诺啡是一种安全有效的阿片类药物戒毒药物。由于其相对其他阿片类药物滥用潜力较低,可作为维持方案的一线药物。它在初级保健环境中的有效性使其成为家庭医生有用的治疗工具。

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