Deering Daryle, Sellman J Douglas, Adamson Simon
National Addiction Centre, Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
N Z Med J. 2014 Jul 4;127(1397):57-66.
We provide an overview of the history and philosophy of the treatment for opioid dependence, which has been dominated by methadone substitution treatment for the past 40 years in New Zealand. Although changes in approach have occurred over this time, influenced by various sociopolitical events and changing ideologies, opioid substitution treatment has still "not come of age". It remains undermined by stigma and risk concerns associated with methadone and has struggled to be accessible and attractive to illicit opioid drug users, comprehensive and integrated into mainstream health care. However, the introduction in 2012 of Pharmac-subsidised buprenorphine combined with naloxone (Suboxone) in the context of an emerging trend towards a broader recovery and well-being orientation could signal a new era in treatment. The availability of buprenorphine-naloxone may also facilitate a further shift in treatment from primarily siloed specialist addiction services to integrated primary care services. This shift will help reduce stigma, promote patient self-management and community integration and align opioid substitution treatment with treatment for other chronic health conditions such as diabetes and asthma.
我们概述了阿片类药物依赖治疗的历史与理念，在过去40年里，新西兰的阿片类药物依赖治疗一直以美沙酮替代疗法为主导。尽管在此期间治疗方法发生了变化，受到各种社会政治事件和不断变化的观念的影响，但阿片类药物替代疗法仍“未成熟”。它仍然受到与美沙酮相关的耻辱感和风险担忧的影响，并且在吸引非法阿片类药物使用者、全面且融入主流医疗保健方面一直面临困难。然而，2012年在朝着更广泛的康复和幸福导向这一新兴趋势背景下引入的由药物补贴的丁丙诺啡与纳洛酮合剂（复方丁丙诺啡），可能预示着治疗的新时代。丁丙诺啡 - 纳洛酮的可及性也可能促进治疗从主要孤立的专科成瘾服务进一步转向综合初级保健服务。这一转变将有助于减少耻辱感，促进患者自我管理和社区融入，并使阿片类药物替代疗法与糖尿病和哮喘等其他慢性健康状况的治疗保持一致。
