Passik Steven D
Millennium Laboratories, Inc. and Millennium Research Institute, San Diego, CA, USA,
Adv Ther. 2014 Mar;31(3):264-75. doi: 10.1007/s12325-014-0099-7. Epub 2014 Feb 14.
Pain-including acute or persistent acute pain-is a common condition that is increasingly being treated with opioids in the United States. The acute pain treatment setting may represent a key target for addressing the growing epidemic of prescription drug abuse occurring hand in hand with the rise in opioid prescribing. Balancing the needs of pain treatment with abuse prevention can be challenging for clinicians.
This article identified efforts to balance opioid abuse risks with opioid availability through the extensive experience of the author in this field. In addition, PubMed literature searches using terms such as "prescription opioid abuse", "abuse-deterrent opioids", and "tamper-resistant opioids"; and inspection of the bibliographies of relevant articles were used to identify relevant sources.
These multifaceted efforts have included: improving assessment of patient risk for drug misuse, abuse, or diversion; funding of and encouraging referral to addiction treatment programs; access to and widespread use of prescription monitoring programs (PMPs); public knowledge of prescription opioid abuse; proper storage of opioid medications; and development of new formulations designed to resist tampering and deter abuse. This review discusses the problem of prescription opioid abuse and strategies to minimize risk within the context of acute pain treatment, and explores the potential role of tamper-resistant opioid formulations and other abuse deterrence strategies in the area of acute or persistent acute pain management.
In order to stem the tide of prescription opioid abuse and preserve the availability of opioids as a much needed analgesic option, a multifaceted approach that includes tamper-resistant opioid formulations-for chronic or acute pain-along with strategies such as improved patient risk assessment, funding for and referral to addiction treatment programs, greater use of PMPs, and raised awareness of prescription opioid abuse is needed.
疼痛，包括急性疼痛或持续性急性疼痛，是一种常见病症，在美国，使用阿片类药物治疗的情况日益增多。急性疼痛治疗环境可能是应对与阿片类药物处方量增加相伴而生的日益严重的处方药滥用流行问题的关键目标。对临床医生而言，平衡疼痛治疗需求与预防滥用颇具挑战。
本文通过作者在该领域的丰富经验，确定了平衡阿片类药物滥用风险与可及性的措施。此外，还利用PubMed文献检索，检索词包括“处方阿片类药物滥用”“抗滥用阿片类药物”和“抗篡改阿片类药物”；并查阅相关文章的参考文献以确定相关来源。
这些多方面的努力包括：改进对患者药物误用、滥用或转移风险的评估；为成瘾治疗项目提供资金并鼓励转诊；获取并广泛使用处方监测项目（PMPs）；公众对处方阿片类药物滥用的认知；阿片类药物的妥善储存；以及开发旨在抗篡改和防止滥用的新剂型。本综述讨论了处方阿片类药物滥用问题以及在急性疼痛治疗背景下将风险降至最低的策略，并探讨了抗篡改阿片类药物剂型和其他预防滥用策略在急性或持续性急性疼痛管理领域的潜在作用。
为了遏制处方阿片类药物滥用的趋势，并保持阿片类药物作为急需的镇痛选择的可及性，需要采取多方面的方法，包括用于慢性或急性疼痛的抗篡改阿片类药物剂型，以及诸如改进患者风险评估、为成瘾治疗项目提供资金并转诊、更多使用PMPs以及提高对处方阿片类药物滥用的认识等策略。
